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Sample records for aneurysm neck dynamics

  1. Turnover in intracranial aneurysm phantoms: its relation to neck size

    International Nuclear Information System (INIS)

    Chung, Tae Sub; Lee, Young Jun; Rhim, Yoon Chul

    2003-01-01

    To evaluate the physiologic background of aneurysms poorly visualized during 3D-TOF MRA, contrast-enhanced MRA (CEMRA) and DSA due to hemodynamic isolation. Using handmade elastic silicon phantoms to represent terminal basilar tip aneurysms, 3D-TOF MRA, CEMRA and DSA were used to determine blood turnover. Aneurysmal neck size was 2 mm and 10 mm, and the use of a pulsatile pump also helped recreate human physiologic parameters. We compared the results with those of computational fluid dynamics. DSA images of the narrow-necked aneurysm showed that a small volume of contrast medium washed into it during the systolic phase. As the width of its neck increased, the turnover volume of fragments of contrast bolus also increased. At CEMRA, the broad-necked aneurysm was visualized as the main bolus of Gd-DTPA passed through it, and at delayed CEMRA, the narrow-necked aneurysm was visualized faintly after the passage of bolus Gd-DTPA. The results correlated closely with those of 3D-TOF MRA and computational fluid dynamics. The visualization of intracranial aneurysms at 3D-TOF MRA, CEMRA and DSA was greatly dependent upon blood turnover, which varied according to aneurysmal neck size. A narrow-necked aneurysm might be missed at 3D-TOF MRA, CEMRA and DSA due to hemodynamic isolation

  2. The influence of neck thrombus on clinical outcome and aneurysm morphology after endovascular aneurysm repair

    NARCIS (Netherlands)

    F.M.V. Bastos Gonçalves (Frederico); H.J.M. Verhagen (Hence); K. Chinsakchai (Khamin); J.W. van Keulen (Jasper); M.T. Voûte (Michiel); H.J.A. Zandvoort (Herman); F.L. Moll (Frans); J.A. van Herwaarden (Joost)

    2012-01-01

    textabstractObjective: This study investigated the influence of significant aneurysm neck thrombus in clinical and morphologic outcomes after endovascular aneurysm repair (EVAR). Methods: The patient population was derived from a prospective EVAR database from two university institutions in The

  3. Recurrence of ICA-PCoA aneurysms after neck clipping.

    Science.gov (United States)

    Sakaki, T; Takeshima, T; Tominaga, M; Hashimoto, H; Kawaguchi, S

    1994-01-01

    Between 1975 and 1992, 2211 patients underwent aneurysmal neck clipping at the Nara Medical University clinic and associated hospitals. The aneurysm in 931 of these patients was situated at the junction of the internal carotid artery (ICA) and posterior communicating artery (PCoA). Seven patients were readmitted 4 to 17 years after the first surgery because of regrowth and rupture of an ICA-PCoA aneurysmal sac that had arisen from the residual neck. On angiograms obtained following aneurysmal neck clipping, a large primitive type of PCoA was demonstrated in six patients and a small PCoA in one. A small residual aneurysm was confirmed in only two patients and angiographically complete neck clipping in five. Recurrent ICA-PCoA aneurysms were separated into two types based on the position of the old clip in relation to the new growth. Type 1 aneurysms regrow from the entire neck and balloon eccentrically. In this type, it is possible to apply the clip at the neck as in conventional clipping for a ruptured aneurysm. Type 2 includes aneurysms in which the proximal portion of a previous clip is situated at the corner of the ICA and aneurysmal neck and the distal portion on the enlarged dome of the aneurysm, because the sac is regrowing from a portion of the residual neck. In this type of aneurysm, a Sugita fenestrated clip can occlude the residual neck, overriding the old clip. Classifying these aneurysms into two groups is very useful from a surgical point of view because it is possible to apply a new clip without removing the old clip, which was found to be adherent to surrounding tissue.

  4. Basilar artery aneurysm case presented with neck pain

    Directory of Open Access Journals (Sweden)

    Uygar Utku

    2013-04-01

    Full Text Available Neck pain related with disorders of the brain and neck vascular structures is not rare but importance was attached to a condition that is often overlooked. Tension as a sudden onset, radiating to the nape, the neck pain becomes unbearable and within seconds the raging 51-year-old female patient with aneurysm at the distal end of basilar artery was found. Case, the only sign of neck pain with unruptured basilar artery aneurysm is presented in terms of raising awareness on the subject.

  5. Three-dimensional finite volume modelling of blood flow in simulated angular neck abdominal aortic aneurysm

    Science.gov (United States)

    Algabri, Y. A.; Rookkapan, S.; Chatpun, S.

    2017-09-01

    An abdominal aortic aneurysm (AAA) is considered a deadly cardiovascular disease that defined as a focal dilation of blood artery. The healthy aorta size is between 15 and 24 mm based on gender, bodyweight, and age. When the diameter increased to 30 mm or more, the rupture can occur if it is kept growing or untreated. Moreover, the proximal angular neck of aneurysm is categorized as a significant morphological feature with prime harmful effects on endovascular aneurysm repair (EVAR). Flow pattern in pathological vessel can influence the vascular intervention. The aim of this study is to investigate the blood flow behaviours in angular neck abdominal aortic aneurysm with simulated geometry based on patient’s information using computational fluid dynamics (CFD). The 3D angular neck AAA models have been designed by using SolidWorks Software. Consequently, CFD tools are used for simulating these 3D models of angular neck AAA in ANSYS FLUENT Software. Eventually, based on the results, we summarized that the CFD techniques have shown high performance in explaining and investigating the flow patterns for angular neck abdominal aortic aneurysm.

  6. Evaluation of Aneurysm Neck Angle Change After Endovascular Aneurysm Repair Clinical Investigations

    Energy Technology Data Exchange (ETDEWEB)

    Le, Trong Binh; Moon, Mi Hyoung [Inha University Hospital, Endovascular Training Center (Korea, Republic of); Jeon, Yong Sun, E-mail: radjeon@inha.ac.kr [Inha University Hospital, Inha University School of Medicine, Department of Radiology (Korea, Republic of); Hong, Kee Chun [Inha University School of Medicine, Department of Vascular Surgery (Korea, Republic of); Cho, Soon Gu [Inha University Hospital, Inha University School of Medicine, Department of Radiology (Korea, Republic of); Park, Keun-Myoung [Inha University School of Medicine, Department of Vascular Surgery (Korea, Republic of)

    2016-05-15

    PurposeTo evaluate the aneurysm neck angle changes and post-endovascular aneurysm repair (EVAR) complications.MethodsWe retrospectively analyzed 72 cases of elective EVAR for abdominal aortic aneurysm among 109 consecutive cases from December 2005 to April 2014. Patients were divided into angulated and non-angulated groups. The angulated group was defined as neck angulation ≥60°. Neck angle was evaluated pre- and post-EVAR during short- (within 1 month), mid- (3–6 months), and long-term (>1 year) follow-up. Aneurysm sac diameter change, aneurysm neck morphology other than angulation, endoleaks, and other post-procedural complications were also documented.ResultsA total of 34 patients were enrolled in the angulated group. There were no statistical differences in age, sex, follow-up duration, and aneurysm neck profile between the two groups (p > 0.05). Both groups showed statistically significant and consistent decreases in angulation during the follow-up period (p < 0.01). The angulated group revealed 22.45 % more straightening than the non-angulated group. Recoil of the Endurant device occurred in the angulated group. No statistically significant intergroup differences were observed in any endoleaks, complications, or re-intervention rates (p > 0.05). Pre-EVAR angle was the only predictor for post-procedural angle change (p < 0.001).ConclusionEVAR is applicable for patients with highly angulated aneurysm neck and provides consistent neck straightening over long-term follow-up. Recoil was evident in the angulated group using the Endurant device.

  7. Comparison of CT angiography and digital subtraction angiography in the evaluation of intracranial aneurysmal neck

    International Nuclear Information System (INIS)

    Kim, Yoo Kyung; Baik, Seung Kug; Shin, Mi Jeong; Choi, Han Yong

    2001-01-01

    To compare the usefulness of three-dimensional multislice CT angiography(CTA) and digital subtraction angiography (DSA) in the evaluation of intracranial aneurysmal neck. Nineteen patients with intracranial aneurysm (23 cases) underwent DSA and subsequent CTA. Using a multislice CT scanner and the SSD(shaded surface display) technique, clipping, cutting and the MPR technique, three-dimensional images were obtained. These were (a) external, (b) internal, from the direction of the parent artery, (c) internal, from the direction of the aneurysmal dome, and (d) an aneurysmal cutting image. The CTA findings were retrospectively compared with the DSA images. Twenty aneurysms were small and three were large. In eleven cases aneurysm neck was small, in nine it was wide, and in three it was relatively wide. For aneurysmal neck evaluation, CTA was superior to DSA in six of nine wide-neck aneurysms and all three large-sized wide-neck aneurysms. In small neck aneurysms 8 of 11 cases and in relatively wide neck all 3 cases showed similarly good images by both modalities. Of the 23 cases demonstrated by four different images, 14 cases showed the best image in internal image from parent artery direction and 6 cases showed similarly good image in both aneurysmal cutting image and internal image from parent artery direction. In the evaluation of wide neck aneurysms, 7 of 9 cases showed the best image at internal image from parent artery direction, compared with other three different images. In two cases of aneurysms, calcification was visible in the aneurysmal wall, so it was difficult to evaluate the aneurysmal neck. CTA was superior to DSA in the evaluating the intracranial aneurysmal neck. CTA maybe an additional available modality to evaluate the aneurysmal neck which is difficult to detect by the DSA. And the information of intracranial aneurysmal neck through CTA will be of value in surgical and endovascular treatment

  8. Intra-aneurysmal flow disruption after implantation of the Medina® Embolization Device depends on aneurysm neck coverage.

    Science.gov (United States)

    Frölich, Andreas Maximilian; Nawka, Marie Teresa; Ernst, Marielle; Frischmuth, Isabell; Fiehler, Jens; Buhk, Jan-Hendrik

    2018-01-01

    Flow disruption achieved by braided intrasaccular implants is a novel treatment strategy for cerebrovascular aneurysms. We hypothesized that the degree of intra-aneurysmal flow disruption can be quantified in vitro and is influenced by device position across the aneurysm neck. We tested this hypothesis using the Medina® Embolization Device (MED). Ten different patient-specific elastic vascular models were manufactured. Models were connected to a pulsatile flow circuit, filled with a blood-mimicking fluid and treated by two operators using a single MED. Intra-aneurysmal flow velocity was measured using conventional and high-frequency digital subtraction angiography (HF-DSA) before and after each deployment. Aneurysm neck coverage by the implanted devices was assessed with flat detector computed tomography on a three-point Likert scale. A total of 80 individual MED deployments were performed by the two operators. The mean intra-aneurysmal flow velocity reduction after MED implantation was 33.6% (27.5-39.7%). No significant differences in neck coverage (p = 0.99) or flow disruption (p = 0.84) were observed between operators. The degree of flow disruption significantly correlated with neck coverage (ρ = 0.42, 95% CI: 0.21-0.59, p = 0.002) as well as with neck area (ρ = -0,35, 95% CI: -0.54 --0.13, p = 0.024). On multiple regression analysis, both neck coverage and total neck area were independent predictors of flow disruption. The degree of intra-aneurysmal flow disruption after MED implantation can be quantified in vitro and varies considerably between different aneurysms and different device configurations. Optimal device coverage across the aneurysm neck improves flow disruption and may thus contribute to aneurysm occlusion.

  9. A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Werner; Kuehne, Dietmar [Alfried Krupp Hospital, Department of Radiology and Neuroradiology, Essen (Germany); Bendszus, Martin; Solymosi, Laszlo [University of Wuerzburg, Department of Neuroradiology, Wuerzburg (Germany); Kis, Bernhard [University of Duisburg-Essen, Research Unit, Rheinische Kliniken Essen, Department of Psychiatry and Psychotherapy, Essen (Germany); Boulanger, Thierry [Centre Hospitalier of Luxembourg, Service of Neuroradiology, Luxembourg (Luxembourg)

    2007-07-15

    We report the results of a prospective clinical study using a new self-expanding nitinol stent (Enterprise) designed for the treatment of wide-necked intracranial aneurysms. We treated 31 saccular, wide-necked intracranial aneurysms in 30 patients. Ten aneurysms had recanalized after prior endovascular treatment without a stent, and 21 aneurysms had not been treated before. Stent deployment was successful in all procedures. Additional coil embolization was performed in all aneurysms. Initial complete angiographic occlusion was achieved in 6 aneurysms, a neck remnant was left in 18 aneurysms and there were 7 residual aneurysms. Angiographic follow-up examinations of 30 lesions after 6 months demonstrated 15 complete occlusions, 8 neck remnants and 7 residual aneurysms. One patient refused the 6-month angiographic follow-up. Spontaneous occlusion of the aneurysm had occurred in 14 patients, and 6 aneurysms showed recanalization. Four of these residual aneurysms were retreated. At the 6-month follow-up, 29 parent arteries were unaffected, whereas two parent vessels demonstrated minor asymptomatic narrowing at the stent site. Two patients experienced one or more possible or probable device-related serious adverse events during the 6-month follow-up period. There was no procedural morbidity or mortality at 6 months after the procedure. The reported results demonstrated the safety and feasibility of the Cordis Neurovascular Enterprise stent in the treatment of wide-necked intracranial aneurysms. Initial clinical and angiographic results are favorable. (orig.)

  10. Treatment of intracranial wide neck aneurysm with neuroform self-expanding stent combined with spring coils

    International Nuclear Information System (INIS)

    Bai Weixing; Jiang Xifeng; Li Tianxiao; Zhai Shuiting; Xue Jiangyu; Wang Ziliang; Cao Huicun

    2008-01-01

    Objective: To evaluate the preliminary experience of the combined self-expanding neurovascular stent (Neuroform stent) with detachable coils in the management of intracranial wide neck aneurysms. Methods: Self-expanding neurovascular stents with detachable coils were used in treating 27 intracranial wide neck aneurysms of 25 patients including cavernous segment ICA aneurysms in 3, ophthalmic arterial anemysm in 1, PcomA in 18, AcomA in 2, MCAM1 in 1, MCA bifurcation in 1, and basilar trunk in 1. Among them, 2 cases consisted of multi-aneurysms, 2 aneurysms coincide with absolute wide neck (> 4 mm) and 6 with comparatively wide neck (> 7 mm). Nemoform stents were deployed across the neck of aneurysm and detachable coils were released to embolize the aneurysm through stent mesh. Results: Twenty-six Neuroform stents were successfully deployed in 25 patients including 4 Neuroform II stents, and 22 Neurofom III stents(all combined with spring coils). Total occlusion was achieved in 7 patients with residual neck in 9 nearly complete occlusion and partial occlusion in 11. 2 patients were rebleeding and other 2 showed intra-stent thrombosis during the operations. The latter 2 included 1 with post-operative limb paraplegia and 1 died. Still another 1 had transient ischemic attack after the operation. Twenty-three patient recovered well. Twenty-four patients were under clinical followed up from 0.5 to 28 months with an average of 10.8 months. There was no bleeding. Three patients were angiographically followed up for 3-6 months after the procedure, with only 1 case of in-stent thrombosis and no change in other 2 aneurysms with neck remnant. Conclusions: The Neuroform stent is technically feasible and safe for treating intracranial wide neck aneurysms unsuitable for clipping because of its prevention for coil protruding into parent artery. The long term effect still need to be further investigated. (authors)

  11. WEB-DL endovascular treatment of wide-neck bifurcation aneurysms

    DEFF Research Database (Denmark)

    Lubicz, B; Klisch, J; Gauvrit, J-Y

    2014-01-01

    BACKGROUND AND PURPOSE: Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data...... in patients treated with WEB-DL. MATERIALS AND METHODS: Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion...... was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant. RESULTS: Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations...

  12. Endovascular treatment of wide-necked aneurysms using stents combined with electrolytic detachable coils in a canine model

    International Nuclear Information System (INIS)

    Liu Jianmin; Zhang Xin; Zhou Xiaoping; Hong Bo; Xu Yi; Huang Qinghai; Zhang Long; She Jiagui; Zhao Rui

    2004-01-01

    Objective: To assess hemodynamics and histology of the aneurysms by treating experimental wide-necked aneurysms endovascularly with a combination of stents and electrolytic detachable coils. Methods: An experimental model was surgically constructed in the necks of six canines for simulating intracranial wide-necked aneurysms. Balloon-expandable metal stents were positioned across the aneurysms in bilateral carotid arteries of six canines with additional intraaneurysmal placement of detachable microcoils in only unilateral carotid artery of each canine. Sonography and angiography were performed in different stages and histologic examinations were achieved finally. Results: Stent placement was successful in all six canines. Aneurysms treated with only stents placement showed no significant thrombus formation with slow growing of neointima over the neck of the aneurysm. Thrombosis occurred in the aneurysms treated with stents and coils in a short time and neointima covered the neck of the aneurysms completely. Conclusions: Endovascular treatment of wide-necked aneurysms using stents combined with electrolytic detachable coils may prevent re-rupture of the aneurysms and promote neointima formation over the neck of the aneurysms. (authors)

  13. Sole stenting treatment for small wide-necked saccular intracranial aneurysms:a clinical therapeutic analysis

    International Nuclear Information System (INIS)

    Cheng Jiyong; Hong Bo; Xu Yi; Huang Qinghai; Yang Pengfei; Zhao Wenyuan; Liu Jianmin

    2010-01-01

    Objective: To discuss the feasibility, safety and efficacy of sole stenting technique for the treatment of small wide-necked saccular intracranial aneurysms. Methods: Between February 2001 and November 2009, 36 consecutive patients with small wide-necked saccular intracranial aneurysms (18 males and 18 females, aged 19-75 years,with a mean age of 52.3 years) were treated with stenting technique only. Of 36 patients, the Grade 0 of Hunt and Hess classification was seen in 22,Grade I in 8, Grade II in 5 and Grade III in 1. The aneurysmal diameter ranged from 1.8 mm to 5.0 mm,with a mean diameter of 3.6 mm. The aneurysms were located at the anterior communicating artery (n=1), posterior communicating artery (n=11), intradural paraclinoid internal carotid artery (n=18), basilar artery (n=1), anterior choroidal artery (n=4) or middle cerebral artery (n=1). The clinical manifestations, the angiographic findings and the follow-up observations were analyzed and the results were evaluated by means of the Modified Rankin Scale, magnetic resonance angiography and digital subtraction angiography. Results: Sole stenting treatment was performed in 36 patients with small wide-necked saccular intracranial aneurysms. A total of 37 stents were successfully delivered and deployed at the targeted location. Immediate post-procedural angiography showed that complete occlusion was obtained in one aneurysm, a sluggish intra-aneurysmal vortex motion in 3 aneurysms and a correction of the angle of the parent vessel in two cases, whereas no change was seen in the remaining 30 aneurysms. Angiographic follow-up was carried out in 22 of the 36 patients (61%) during a mean following-up period of 16 months (ranged from 3 to 59 months). The follow-up angiography showed that the complete occlusion was seen in 11 cases, narrowed aneurysmal neck with shrinkage of the aneurysm in 9 cases, narrowed aneurysmal neck only in 1 case, and shrinkage of the aneurysm only in 1 case.All the patients remained

  14. Computational fluid dynamics (CFD) using porous media modeling predicts recurrence after coiling of cerebral aneurysms.

    Science.gov (United States)

    Umeda, Yasuyuki; Ishida, Fujimaro; Tsuji, Masanori; Furukawa, Kazuhiro; Shiba, Masato; Yasuda, Ryuta; Toma, Naoki; Sakaida, Hiroshi; Suzuki, Hidenori

    2017-01-01

    This study aimed to predict recurrence after coil embolization of unruptured cerebral aneurysms with computational fluid dynamics (CFD) using porous media modeling (porous media CFD). A total of 37 unruptured cerebral aneurysms treated with coiling were analyzed using follow-up angiograms, simulated CFD prior to coiling (control CFD), and porous media CFD. Coiled aneurysms were classified into stable or recurrence groups according to follow-up angiogram findings. Morphological parameters, coil packing density, and hemodynamic variables were evaluated for their correlations with aneurysmal recurrence. We also calculated residual flow volumes (RFVs), a novel hemodynamic parameter used to quantify the residual aneurysm volume after simulated coiling, which has a mean fluid domain > 1.0 cm/s. Follow-up angiograms showed 24 aneurysms in the stable group and 13 in the recurrence group. Mann-Whitney U test demonstrated that maximum size, dome volume, neck width, neck area, and coil packing density were significantly different between the two groups (P CFD and larger RFVs in the porous media CFD. Multivariate logistic regression analyses demonstrated that RFV was the only independently significant factor (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = 0.016). The study findings suggest that RFV collected under porous media modeling predicts the recurrence of coiled aneurysms.

  15. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    Energy Technology Data Exchange (ETDEWEB)

    Muehlenbruch, Georg, E-mail: gmuehlenbruch@ukaachen.de; Nikoubashman, Omid; Steffen, Bjoern; Dadak, Mete [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, University Hospital (Germany); Palmowski, Moritz [RWTH Aachen University, Department of Nuclear Medicine, University Hospital (Germany); Wiesmann, Martin [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, University Hospital (Germany)

    2013-02-15

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  16. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    International Nuclear Information System (INIS)

    Mühlenbruch, Georg; Nikoubashman, Omid; Steffen, Björn; Dadak, Mete; Palmowski, Moritz; Wiesmann, Martin

    2013-01-01

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  17. Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation

    International Nuclear Information System (INIS)

    Xing Ming; Yang Pengfei; Huang Qinghai; Zhao Wenyuan; Hong Bo; Xu Yi; Liu Jianmin

    2012-01-01

    Objective: To preliminarily evaluate the feasibility, safety and efficacy of stent placement for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation. Methods: Eleven patients with wide-necked aneurysms located at internal carotid artery bifurcation, who were encountered during the period from Jan. 2004 to Dec. 2010 in hospital, were collected. A total of 16 intracranial aneurysms were detected, of which 11 were wide-necked and were located at internal carotid artery bifurcation. The diameters of the aneurysms ranged from 2.5 mm to 18 mm. Individual stent type and stenting technique was employed for each patient. Follow-up at 1, 3, 6 and 12 months after the procedure was conducted. Results: A total of 11 different stents were successfully deployed in the eleven patients. The stents included balloon expandable stent (n=1) and self-expanding stent (n=10). According to Raymond grading for the immediate occlusion of the aneurysm, grade Ⅰ (complete obliteration) was obtained in 4, grade Ⅱ (residual neck) in 2 and grade Ⅲ (residual aneurysm) in 5 cases. No procedure-related complications occurred. At the time of discharge, the modified Rankin score was 0-1 in the eleven patients. During the follow-up period lasting for 1-108 months, all the patients were in stable condition and no newly-developed neurological dysfunction or bleeding observed. Follow-up examination with angiography (1-48 months) showed that the aneurysms were cured (no visualization) in 4 cases, improved in 2 cases and in stable condition in one case. Conclusion: For the treatment of wide-necked aneurysms located at internal carotid artery bifurcation, stent implantation is clinically feasible, safe and effective. Further studies are required to evaluate its long-term efficacy. (authors)

  18. The comparison of aneurysmal necks measured on three dimensional reconstruction images of rotational DSA and those of traditional DSA

    International Nuclear Information System (INIS)

    Wu Chunhong; Chen Zuoquan; Gu Binxian; Zhang Guiyun

    2006-01-01

    Objective: To evaluate the value of three dimensional reconstruction images of rotational DSA on measuring aneurysmal necks and make a comparison with traditional DSA so as to provide more abundant and accurate information for the embolization of aneurysm. Methods: A comparison was made between the measurement of aneurismal necks from 14 cases with traditional DSA examination and a measurement made on three dimensional reconstruction images of the same patients. Results: There was a difference shown in the measurement of the aneurysmal necks between three dimensional reconstruction images of rotational DSA and those of traditional DSA, outcoming with more angles and data on three dimensional reconstruction images. Conclusions: There are more angles of aneurysmal neck can be shown on rotational 3D DSA especially for the demonstration of the largest aneurysmal neck with a directional value for the intervention. (authors)

  19. Enterprise stent for waffle-cone stent-assisted coil embolization of large wide-necked arterial bifurcation aneurysms.

    Science.gov (United States)

    Padalino, David J; Singla, Amit; Jacobsen, Walter; Deshaies, Eric M

    2013-01-01

    Large wide-necked arterial bifurcation aneurysms present a unique challenge for endovascular coil embolization treatment. One technique described in the literature deploys a Neuroform stent into the neck of the aneurysm in the shape of a waffle-cone, thereby acting as a scaffold for the coil mass. This case series presents four patients with large wide-necked bifurcation aneurysms treated with the closed-cell Enterprise stent using the waffle-cone technique. Four patients (59 ± 18 years of age) with large wide-necked arterial bifurcation aneurysms (three basilar apex and one MCA bifurcation) were treated with the waffle-cone technique using the Enterprise stent as a supporting device for stent-assisted coil embolization. Three of the patients presented with aneurysmal subarachnoid hemorrhage (Hunt-Hess 2-3; Fisher Grade 3-4). There was no procedural morbidity or mortality associated with treatment itself. One aneurysm was completely obliterated, and three had small residual necks. One patient developed an area of PCA infarct and visual field cut one month after the procedure and required recoiling of the residual neck. The flared ends of the Enterprise stent remodeled the aneurysm neck by conforming to the shape of the neck without any technical difficulty, resulting in a stable scaffold holding the coils into the aneurysm. The closed cell construction, flexibility, and flared ends of the Enterprise stent allow it to conform to the waffle-cone configuration and provide a stable scaffold for coil embolization of large wide-necked arterial bifurcation aneurysms. We have had excellent initial results using the Enterprise stent with the waffle-cone technique. However, this technique is higher risk than standard treatment methods and therefore should be reserved for large wide-necked bifurcation aneurysms where Y stenting is needed, but not possible, and surgical clip ligation is not an option.

  20. Dynamic CT in dissecting aortic aneurysm

    International Nuclear Information System (INIS)

    Fujita, Nobuyuki; Matsuoka, Yosuke; Mizuo, Hideyo; Shirato, Hiroki; Irie, Goro

    1985-01-01

    especially about the branching of major vessels Eight cases of aortic dissection were analysed to evaluate detectability of the branching of major vessels from a ture or false lumen, by dynamic CT. Although recognition of the branching is easy when the direct continuity to a dissected lumen is demonstrated, but without visualization of direct continuity or with no information about dissected lumens, it is sometimes difficult or leads us to misdiagnosis. The diagnostic accuracy is 100% when direct continuity to a dissected lumen is demonstrated, or dynamic CT revealed branching pattern distinctly. Dynamic CT is useful for a diagnosis of dissecting aneurysm and branching pattern of major vessels. (author)

  1. Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Jung, Hye Doo; Lee, Yun Young; Lee, Seung Jin; Yim, Nam Yeol; Kim, Jae Kyu; Choi, Soo Jin Na; Jung, Sang Young; Chang, Nam Kyu; Lim, Jae Hoon

    2012-01-01

    To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta. This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types. There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p 0.043) showed a high incidence rate of complications within a year. The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

  2. The diagnostic value of three-dimensional dynamic contrast-enhanced MR angiography for intracranial aneurysms

    International Nuclear Information System (INIS)

    Liu Qi; Lu Jianping; Wang Fei; Wang Li; Tian Jianming; Jin Aiguo; Zeng Hao

    2003-01-01

    Objective: To assess the clinical value of three-dimensional dynamic contrast-enhanced MR angiography (3D DCE-MRA) in the detection for intracranial aneurysm. Methods: 3D DCE-MRA was performed in 54 patients highly suspected with intracranial aneurysms. Then conventional digital subtraction angiography (DSA) and feasible endovascular treatment were performed simultaneously. A three-dimensional fast imaging with steady state precession (3D FISP) was used for 3D DCE-MRA(Gd-DTPA dose, 0.2 mmol per kilogram for body weight; acquisition time, 10 seconds). The source images were subtracted from mask images and transferred to computer workstation. All images were subsequently post-processed using three-dimensional reconstruction. 3D DCE-MRA images and DSA images were compared for demonstration of the aneurysm, its neck, and relationship with parent artery, and the usefulness for endovascular treatment was evaluated. Results: There were 39 cases with 45 intracranial aneurysms. The sensitivity, specificity, and accuracy of 3D DCE-MRA were 96%, 73% and 90%, respectively. Aneurysm and its neck depiction at 3D DCE-MRA was significantly better than that at DSA, especially for aneurysms adjacent to the cavernous sinus and near the PICA of vertebral artery. 3D DEC-MRA could guide neurosurgeons to the desired DSA projection, and helped them make plan for interventional or surgical treatment in advance. But the diagnosis should be very carefully made for small aneurysms located in the periphery and the arterial bifurcation. Conclusion: 3D DEC-MRA is a fast, noninvasive and efficient technique for diagnosing intracranial aneurysms. Its three dimensional information is helpful for DSA demonstration and treatment planning. Any uncertain diagnosis requires DSA confirmation

  3. Endovascular treatment of acutely ruptured, wide-necked anterior communicating artery aneurysms using the Enterprise stent.

    Science.gov (United States)

    Huang, Qing-Hai; Wu, Yong-Fa; Shen, Jie; Hong, Bo; Yang, Peng-Fei; Xu, Yi; Zhao, Wen-Yuan; Liu, Jian-Min

    2013-02-01

    The treatment of anterior communicating artery (AcomA) wide-necked aneurysms with the Enterprise stent (Codman, Miami Lakes, FL, USA) has not been commonly described, due to the complexity of the vascular anatomy and the small vessels of the AcomA complex. To evaluate the feasibility, effectiveness and safety of Enterprise stent placement in AcomA aneurysms, we performed this retrospective study. Between November 2008 and December 2010, 27 wide-necked AcomA ruptured aneurysms were treated within 72 hours of ictus with the Enterprise stent. Data collected and analyzed were: demographic data, morphologic features of the aneurysm, treatment results and follow-up results. Twenty-nine Enterprise stents were successfully deployed in all 27 aneurysms, including Y-configuration stent deployment in two patients. The initial embolization degrees were Raymond class I in 20 patients, class II in five and class III in the other two. The angiographic follow-up of 21 patients (mean, 8.4 months) showed that all aneurysms remained stable or improved; there was no in-stent stenosis, recurrence or retreatment. The clinical follow-up of 26 patients (mean, 12.6 months) showed that 23 patients displayed no symptoms and no or mild disability; three patients remained with severe or moderately severe disability. The Enterprise stent is feasible and safe for endovascular embolization of wide-necked AcomA ruptured aneurysms. Further follow up is needed to assess the long-term efficacy of Enterprise stent placement in AcomA. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Choke, Edward; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria; Loftus, Ian; McFarland, Robert; Loosemore, Thomas; Thompson, Matthew M.

    2006-01-01

    Purpose. The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed to evaluate outcomes in patients with challenging proximal aortic neck anatomy. Methods. Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck diameter >28 mm, angulation >60 deg., circumferential thrombus >50%, and length 30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak (p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05-9.04). Conclusion. Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded to include patients with hostile neck anatomy

  5. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy.

    Science.gov (United States)

    Tam, Matthew D B S; Laycock, Stephen D; Brown, James R I; Jakeways, Matthew

    2013-12-01

    To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

  6. A novel intracranial enterprise stent together with colis for the treatment of very small intracranial wide-necked aneurysms

    International Nuclear Information System (INIS)

    Huang Haidong; Zhao Kai; Gu Jianwen; Qu Yan; Yang Tao; Xia Xun; Lin Long; Zhang Hui

    2010-01-01

    Objective: To make a preliminary investigation and summary of the technique and efficacy of the novel intracranial stent, Enterprise, together with hydro-detachable coils for the treatment of very small intracranial wide-necked aneurysms (diameter < 3 mm and body-to-neck ratio < 1.5). Methods: Six cases with very small intracranial wide-necked aneurysms were treated with Enterprise stents and hydrodetachable coils. In 5 cases the Enterprise stent was implanted to cover the neck of the aneurysm, which was followed by the introduction of a microcatheter into the aneurysmal sac through the stent mesh to stuff hydrodetachable coils in order to fill the aneurysmal sac. In the remaining case, the microcatheter was placed into the aneurysmal sac before the Enterprise stent was inserted to embolize the aneurysm. Postoperative follow-up was conducted for 3-6 months. Results: The operation was successfully completed in all 6 patients, with the implanted stents being in right place. The parent arteries remained patency in all patients. No complications occurred. Complete occlusion of aneurysmal cavity was obtained in four cases, and the occlusion degree of the aneurysmal cavity above 95% was seen in 2 cases. After the procedure, all the patients recovered well. Neither rebleeding nor symptoms related to thrombosis occurred during a clinic followup of 3-6 months. Conclusion: Endovascular embolization with Enterprise stent together with hydrodetachable coils is a safe and effective method for the treatment of very small intracranial wide-necked aneurysms.However, its long-term effect needs to be further observed. (authors)

  7. Crossing Y-stent technique with dual open-cell stents for coiling of wide-necked bifurcation aneurysms.

    Science.gov (United States)

    Ko, Jun Kyeung; Han, In Ho; Cho, Won Ho; Choi, Byung Kwan; Cha, Seung Heon; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2015-05-01

    Double stenting in a Y-configuration is a promising therapeutic option for wide-necked cerebral aneurysms not amenable to reconstruction with a single stent. We retrospectively evaluated the efficacy and safety of the crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms. By collecting clinical and radiological data we evaluated from January 2007 through December 2013, 20 wide-necked bifurcation aneurysms. Twelve unruptured and eight ruptured aneurysms in 20 patients were treated with crossing Y-stent-assisted coiling. Aneurysm size and neck size ranged from 3.2 to 28.2mm (mean 7.5mm) and from 1.9 to 9.1mm (mean 4.5mm). A Y-configuration was established successfully in all 20 patients. All aneurysms were treated with a pair of Neuroform stents. The immediate angiographic results were total occlusion in 17 aneurysms, residual neck in two, and residual sac in one. Peri-operative morbidity was only 5%. Fifteen of 18 surviving patients underwent follow-up conventional angiography (mean, 10.9 months). The result showed stable occlusion in all 15 aneurysms and asymptomatic in-stent occlusion in one branch artery. At the end of the observation period (mean, 33.5 months), all 12 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS 0), except one (mRS 2). Of eight patients with subarachnoid hemorrhage, four remained symptom free (mRS 0), while the other four had were dependent or dead (mRS score, 3-6). In this report on 20 patients, crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms showed a good technical safety and favorable clinical and angiographic outcome. Copyright © 2015. Published by Elsevier B.V.

  8. Treatment of Wide-Neck Bifurcation Aneurysm Using "WEB Device Waffle Cone Technique".

    Science.gov (United States)

    Mihalea, Cristian; Caroff, Jildaz; Rouchaud, Aymeric; Pescariu, Sorin; Moret, Jacques; Spelle, Laurent

    2018-05-01

    The endovascular treatment of wide-neck bifurcation aneurysms can be challenging and often requires the use of adjunctive techniques and devices. We report our first experience of using a waffle-cone technique adapted to the Woven Endoluminal Bridge (WEB) device in a large-neck basilar tip aneurysm, suitable in cases where the use of Y stenting or other techniques is limited due to anatomic restrictions. The procedure was complete, and angiographic occlusion of the aneurysm was achieved 24 hours post treatment, as confirmed by digital subtraction angiography. No complications occurred. The case reported here was not suitable for Y stenting or deployment of the WEB device alone, due to the small caliber of both posterior cerebral arteries and their origin at the neck level. The main advantage of this technique is that both devices have a controlled detachment system and are fully independent. To our knowledge, this technique has not been reported previously and this modality of treatment has never been described in the literature. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Combined stent implantation and embolization with liquid 2-polyhydroxyethyl methacrylate for treatment of experimental canine wide-necked aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Klisch, J.; Zitt, J.; Schumacher, M. [Section of Neuroradiology, University of Freiburg (Germany); Schellhammer, F. [Department of Radiology, University of Cologne, Cologne (Germany); Scheufler, K.M. [Department of Neurosurgery, University of Freiburg (Germany); Pagenstecher, A. [Department of Neuropathology, University of Freiburg, Freiburg (Germany); Nagursky, H. [Department of Oral and Maxillofacial Surgery, University of Freiburg, Freiburg (Germany)

    2002-06-01

    The purpose of the study was the evaluation of 2-polyhydroxyethyl methacrylate (2-P-HEMA) for endovascular liquid embolization of experimental side-wall aneurysms following stent protection in a canine model. The swelling behaviour and polymerization characteristics of 2-P-HEMA in different solutions were investigated in vitro. Different methods for applications were tested in a latex aneurysm model under pulsatile flow conditions. Twenty broad-based carotid side-wall aneurysms were microsurgically produced in five dogs. Four weeks after surgery self-expandable nitinol stents were placed, covering the orifice of the aneurysms. 2-P-HEMA was injected via a microcatheter, which was positioned through the meshwork of the stent. Control angiography was performed immediately after treatment and after 1, 6 and 9 months. In-vivo stent placement succeeded in all but one case. Two aneurysms occluded spontaneously after stent placement. Combined embolization of 17 aneurysms using a stent and 2-P-HEMA was performed. Eleven aneurysms could be primarily completely occluded (65%). A small remaining neck was evident in six aneurysms. Efflux of 2-P-HEMA during the process of embolization was observed in seven aneurysms, due to an excess volume of 2-P-HEMA. The excessive 2-P-HEMA led to significant vessel stenosis in two cases. Two carotid arteries (three treated aneurysms) occluded after 1 month, due to insufficient anticoagulation management. Histological examination of embolized aneurysms revealed no foreign-body or inflammatory reaction. A smooth neo-intimal layer covered the stented vessel segment. Liquid embolization of side-wall aneurysms with 2-P-HEMA is technically feasible. Embolotherapy of aneurysms with liquid agents still has the risk that embolic material will exit even when it is stent-protected. To avoid this problem, stents with smaller strut diameter and/or additional balloon-protection are required. The inert 2-P-HEMA seems to be a promising agent for combining

  10. Abdominal aortic aneurysm neck remodeling after Anaconda stent graft implantation.

    Science.gov (United States)

    Vukovic, Elisabeth; Czerny, Martin; Beyersdorf, Friedhelm; Wolkewitz, Martin; Berezowski, Mikolaj; Siepe, Matthias; Blanke, Philipp; Rylski, Bartosz

    2018-05-24

    The aim of this study was to define how the proximal landing zone changes geometrically after endovascular abdominal aortic aneurysm repair (EVAR) with the Anaconda (Vascutek, Inchinnan, United Kingdom) stent graft. Among 230 patients who underwent Anaconda stent graft implantation between 2005 and 2014, we included 126 with adequate computed tomography (CT) image quality and follow-up. CT analysis entailed the geometric changes in the main body, proximal rings, and proximal landing zone. The median CT follow-up was 2.0 years (345.8 patients-years). The proximal portion of the main body ring system flattened within the first year after EVAR, resulting in an up to 30° increase in the upper ring's angle in 40% patients and up to 40° increase in 24% patients. One year after EVAR, the upper ring angle increase slowed down. Aortic diameter measured at the level of the upper and lower ring expanded by 2 to 4 mm within 1 year, but remained unchanged afterward. The main body migrated continuously down toward the aortic bifurcation, attaining an average 6-mm increase in the distance between the superior mesenteric artery and main body within 4 years. Freedom from endoleak type IA was 95 ± 2% and 93 ± 3% after 1 and 4 years, respectively. The Anaconda main body ring system in its proximal portion flattens within the first year after EVAR, leading to an increase of 2 to 4 mm in the proximal landing zone's aortic diameter. The main body migrates slowly but continuously down toward the aortic bifurcation. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  11. Usefulness of virtual endoscopy for evaluating the relationship between the neck of intracranial aneurysm and surrounding vessels

    International Nuclear Information System (INIS)

    Ikeda, Jota; Horie, Hitoshi; Ishikura, Reiichi; Ando, Kumiko; Morikawa, Tsutomu; Tominaga, Satoru; Nakao, Norio

    2000-01-01

    Application of three-dimensional CT virtual endoscopy for evaluation of the neck and surrounding vessels of intracranial aneurysms. 3D-CT virtual endoscopy (VE) is a reconstructed image using computer processing of 3D-CT images. We evaluated the usefulness of a virtual endoscopy to analyze the relationship between the neck of an intracranial aneurysm and the surrounding vessels. Eight cases with intracranial aneurysms underwent digital subtraction angiography (DSA) and enhanced CT with transarterial infusion of contrast media. 3D-CT angiogram (3D-CTA) and virtual endoscopic images were obtained from the CT image data sets using surface rendering method. The relationship between the neck of an intracranial aneurysm and the surrounding vessels was confirmed by operation or IVR. VE clearly visualized the neck and surrounding vessels in all cases. Operation/IVR findings agreed with the virtual endoscopic findings in all cases, but not with the DSA or 3D-CTA findings in 4 and 2 cases, respectively. 3D-CTA and virtual endoscopy clearly visualizes the relationship between cerebral aneurysms and surrounding vessels, which is useful for determining IVR procedures. (author)

  12. Stent-assisted coiling of wide-neck bifurcation aneurysms with a branch incorporated in the aneurysm base: long-term follow-up in 49 patients with 53 aneurysms.

    Science.gov (United States)

    Lubicz, Boris; Morais, Ricardo; Bruyère, Pierre-Julien; Ligot, Noémie; Mine, Benjamin

    2017-06-01

    Wide-neck bifurcation intracranial aneurysms (WNBA) with a branch incorporated in the aneurysm base remain difficult to treat by embolization. We aim to report our long-term follow-up of stent-assisted coiling (SAC) in this subgroup of patients. This study was approved by our local ethical committee. A retrospective review of our prospectively maintained database identified all patients treated in our institution by SAC for a WNBA with a branch incorporated in the aneurysm base. Technical issues, immediate, long-term outcomes were evaluated. Between 2007 and 2015, 49 patients with 53 intracranial aneurysms (IAs) (52 unruptured, 1 ruptured) were identified and successfully treated. No morbidity/mortality occurred. The incorporated branch was preserved in all patients but one who was treated during a vasospasm phase. At the first 6-month imaging control, the branch was patent. Immediate occlusion was near-complete in 11/53 aneurysms (20.8%), neck remnant in 20/53 aneurysms (37.7%), and incomplete in 22/53 aneurysms (41.5%). Available imaging follow-up of 47 IAs, ranging from 3 to 84 months (mean 26 months ± 19.6 months), showed 27 progressive thrombosis (57.4%), 17 stable occlusions (36.2%), 1 minor recanalization (2.1%), and 2 significant recanalizations that were retreated (4.3%). The latest imaging control showed 30 near-complete occlusions (63.8%), 13 neck remnants (27.7%), and 4 incomplete occlusions (8.5%). Stent-assisted coiling is safe and effective for the treatment of WNBA with a branch incorporated in the aneurysm base. Despite poor immediate anatomical results, long-term follow-up shows a high rate of progressive thrombosis achieving adequate and stable occlusion in most patients.

  13. Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair

    International Nuclear Information System (INIS)

    Belenky, Alexander; Haddad, Menashe; Idov, Igor; Knizhnik, Michael; Litvin, Sergey; Bachar, Gil N.; Atar, Eli

    2009-01-01

    The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization-only if the superior and inferior mesenteric arteries are patent-is a good and safe way to elongate the neck and enable EVAR.

  14. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  15. Use of triple microcatheters for endovascular treatment of wide-necked intracranial aneurysms: A single center experience

    International Nuclear Information System (INIS)

    Cho, Young Dae; Rhim, Jong Kook; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee; Park, Jeong Jin; Jeon, Jin Pyeong

    2015-01-01

    The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms. Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment. The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months). The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations

  16. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  17. Results of the ANSWER Trial Using the PulseRider for the Treatment of Broad-Necked, Bifurcation Aneurysms.

    Science.gov (United States)

    Spiotta, Alejandro M; Derdeyn, Colin P; Tateshima, Satoshi; Mocco, Jay; Crowley, R Webster; Liu, Kenneth C; Jensen, Lee; Ebersole, Koji; Reeves, Alan; Lopes, Demetrius K; Hanel, Ricardo A; Sauvageau, Eric; Duckwiler, Gary; Siddiqui, Adnan; Levy, Elad; Puri, Ajit; Pride, Lee; Novakovic, Roberta; Chaudry, M Imran; Turner, Raymond D; Turk, Aquilla S

    2017-07-01

    The safety and probable benefit of the PulseRider (Pulsar Vascular, Los Gatos, California) for the treatment of broad-necked, bifurcation aneurysms was studied in the context of the prospective, nonrandomized, single arm clinical trial-the Adjunctive Neurovascular Support of Wide-neck aneurysm Embolization and Reconstruction (ANSWER) Trial. To present the results of the United States cases employing the PulseRider device as part of the ANSWER clinical trial. Aneurysms treated with the PulseRider device among sites enrolling in the ANSWER trial were prospectively studied and the results are summarized. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad necked were considered candidates for inclusion into the ANSWER study. Thirty-four patients were enrolled (29 female and 5 male) with a mean age of 60.9 years (27 basilar apex and 7 carotid terminus). Mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range 2.3-11.6 mm). In all patients, the device was delivered and deployed. Immediate Raymond I or II occlusion was achieved in 82.4% and progressed to 87.9% at 6-month follow-up. A modified Rankin Score of 2 or less was seen in 94% of patients at 6 months. The results from the ANSWER trial demonstrate that the PulseRider device is safe and offers probable benefit as for the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist. Copyright © 2017 by the Congress of Neurological Surgeons

  18. Characterizing saccular aortic arch aneurysms from the geometry-flow dynamics relationship.

    Science.gov (United States)

    Natsume, Kayoko; Shiiya, Norihiko; Takehara, Yasuo; Sugiyama, Masataka; Satoh, Hiroshi; Yamashita, Katsushi; Washiyama, Naoki

    2017-06-01

    Low wall shear stress (WSS) has been reported to be associated with accelerated atherosclerosis, aneurysm growth, or rupture. We evaluated the geometry of aortic arch aneurysms and their relationship with WSS by using the 4-dimensional flow magnetic resonance imaging to better characterize the saccular aneurysms. We analyzed the geometry in 100 patients using multiplanar reconstruction of computed tomography. We evaluated WSS and vortex flow using 4-dimensional flow magnetic resonance imaging in 16 of them, which were compared with 8 age-matched control subjects and eight healthy young volunteers. Eighty-two patients had a saccular aneurysm, and 18 had a fusiform aneurysm. External diameter/aneurysm length ratio and sac depth/neck width ratio of the fusiform aneurysms were constant at 0.76 ± 0.18 and 0.23 ± 0.09, whereas those of saccular aneurysms, especially those involving the outer curvature, were higher and more variable. Vortex flow was always present in the aneurysms, resulting in low WSS. When the sac depth/neck width ratio was less than 0.8, peak WSS correlated inversely with luminal diameter even in the saccular aneurysms. When this ratio exceeded 0.8, which was the case only with the saccular aneurysms, such correlation no longer existed and WSS was invariably low. Fusiform aneurysms elongate as they dilate, and WSS is lower as the diameter is larger. Saccular aneurysms dilate without proportionate elongation, and they, especially those occupying the inner curvature, have higher and variable sac depth/neck width ratio. When this ratio exceeds 0.8, WSS is low regardless of diameter, which may explain their malignant clinical behavior. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  19. Direct comparison of Neuroform and Enterprise stents in the treatment of wide-necked intracranial aneurysms

    International Nuclear Information System (INIS)

    Durst, C.R.; Khan, P.; Gaughen, J.; Patrie, J.; Starke, R.M.; Conant, P.; Liu, K.C.; Jensen, M.E.; Evans, A.J.

    2014-01-01

    Aim: To compare the complications and outcomes of Neuroform and Enterprise stents in the treatment of unruptured wide-necked aneurysms. Materials and methods: Under the auspices of the institutional review board, a review of a prospectively collected patient log identified 130 patients who underwent elective stent-assisted coil embolization of a wide-necked aneurysm, including 53 patients treated with an Enterprise stent and 77 patients treated with a Neuroform stent. Immediate and long-term clinical and radiographic outcomes were recorded for all patients. All patient data were handled in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. Results: The technical success rate was 94%. Overall morbidity was 15% with Enterprise stents and 3% with Neuroform stents (p = 0.020). However, the type of stent used was not predictive of clinical outcomes as measured by the modified Rankin scale. In a multivariate analysis, the use of a Neuroform stent was one of the predictors of retreatment (p = 0.034). Conclusion: Multivariate analyses identified the use of Neuroform stents as an independent predictor of the need for retreatment and the use of Enterprise stents as an independent predictor of morbidity. However, the type of stent was not predictive of clinical outcome as measured by the modified Rankin scale. - Highlights: • The use of Enterprise stents was an independent predictor of morbidity. • The use of Neuroform stents was an independent predictor for retreatment. • The type of stent was not predictive of clinical outcome as measured by the mRS

  20. Progressive hematoma in anterior neck after endovascular treatment of middle cerebral artery aneurysm

    Directory of Open Access Journals (Sweden)

    Aysun Ankay Yilbas

    Full Text Available Abstract Background: Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm. Case report: A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5 mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6 mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube. Conclusions: Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.

  1. Successful Aortic Banding for Type IA Endoleak Due to Neck Dilatation after Endovascular Abdominal Aortic Aneurysm Repair: Case Report.

    Science.gov (United States)

    Tashima, Yasushi; Tamai, Koichi; Shirasugi, Takehiro; Sato, Kenichiro; Yamamoto, Takahiro; Imamura, Yusuke; Yamaguchi, Atsushi; Adachi, Hideo; Kobinata, Toshiyuki

    2017-09-25

    A 69-year-old man with a type IA endoleak that developed approximately 21 months after endovascular abdominal aortic aneurysm repair (EVAR) of a 46 mm diameter aneurysm was referred to our department. He had impaired renal function, Parkinson's disease, and previous cerebral infarction. Computed tomography angiography showed a type IA endoleak with neck dilatation and that the aneurysm had grown to 60 mm in diameter. We decided to perform aortic banding. The type IA endoleak disappeared after banding and the patient was discharged on postoperative day 10. Aortic banding may be effective for type IA endoleak after EVAR and less invasive for high-risk patients in particular.

  2. Dutch experience with the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair.

    Science.gov (United States)

    Dijkstra, Martijn L; Tielliu, Ignace F J; Meerwaldt, Robbert; Pierie, Maurice; van Brussel, Jerome; Schurink, Geert Willem H; Lardenoye, Jan-Willem; Zeebregts, Clark J

    2014-08-01

    In the past decennium, the management of short-neck infrarenal and juxtarenal aortic aneurysms with fenestrated endovascular aneurysm repair (FEVAR) has been shown to be successful, with good early and midterm results. Recently, a new fenestrated device, the fenestrated Anaconda (Vascutek, Renfrewshire, Scotland), was introduced. The aim of this study was to present the current Dutch experience with this device. A prospectively held database of patients treated with the fenestrated Anaconda endograft was analyzed. Decision to treat was based on current international guidelines. Indications for FEVAR included an abdominal aortic aneurysm (AAA) with unsuitable neck anatomy for EVAR. Planning was performed on computed tomography angiography images using a three-dimensional workstation. Between May 2011 and September 2013, 25 patients were treated in eight institutions for juxtarenal (n = 23) and short-neck AAA (n = 2). Median AAA size was 61 mm (59-68.5 mm). All procedures except one were performed with bifurcated devices. A total of 56 fenestrations were incorporated, and 53 (94.6%) were successfully cannulated and stented. One patient died of bowel ischemia caused by occlusion of the superior mesenteric artery. On completion angiography, three type I endoleaks and seven type II endoleaks were observed. At 1 month of follow-up, all endoleaks had spontaneously resolved. Median follow-up was 11 months (range, 1-29 months). There were no aneurysm ruptures or aneurysm-related deaths and no reinterventions to date. Primary patency at 1 month of cannulated and stented target vessels was 96%. Initial and short-term results of FEVAR using the fenestrated Anaconda endograft are promising, with acceptable technical success and short-term complication rates. Growing experience and long-term results are needed to support these findings. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  3. Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms.

    Science.gov (United States)

    Jeon, Pyoung; Kim, Byung Moon; Kim, Dong Joon; Kim, Dong I K; Park, Keun Young

    2014-09-01

    This study aimed to evaluate clinical and angiographic outcomes of Y-configuration double-stent-assisted (Y-stent) coiling using two closed-cell stents for wide-necked basilar tip aneurysm (BTA). A total of 25 patients underwent Y-stent coiling using two closed-cell stents as a first-time treatment in 18 (3 ruptured) BTAs, retreatment in 2 BTAs and as a third treatment in 5 wide-necked BTAs. Clinical and angiographic outcomes were evaluated retrospectively. Treatment-related complications were three (12.0 %) thromboembolic infarctions due to two acute in-stent thromboses and one embolism. Twenty-two (88 %) patients had favorable outcomes (modified Rankin scale score [mRS], 0-2) during the follow-up period (mean, 30 months; range, 6-54 months). Two patients died: one from initial subarachnoid hemorrhage and the other from intracerebral hemorrhage due to underlying Moyamoya disease. Post-treatment angiograms showed complete occlusion in nine aneurysms, residual neck in 11 aneurysms and residual sac in five aneurysms. Follow-up angiograms were available at least once between 5 to 34 months (mean, 16 months) in 21 patients. Nineteen patients showed improved or stable states (complete occlusion, n = 17; residual neck, n = 2). Major recurrences occurred in two BTAs (9.5 %). Those two major recurrent aneurysms had been large-sized aneurysms at the initial coiling procedure. Both showed not only coil compaction but also progressive growth to giant-sized aneurysms and intra-aneurysmal thrombus formation at the Y-stent coiling as a third-time treatment. Y-stent coiling using two closed-cell stents is a safe and durable treatment option for wide-necked BTA, but may have limited efficacy for large/giant sized and thrombosed aneurysms.

  4. The Barrel vascular reconstruction device for endovascular coiling of wide-necked intracranial aneurysms: a multicenter, prospective, post-marketing study.

    Science.gov (United States)

    Gory, Benjamin; Blanc, Raphaël; Turjman, Francis; Berge, Jérôme; Piotin, Michel

    2018-02-02

    The Barrel vascular reconstruction device (Barrel VRD) is a novel stent with design features that allow endovascular coiling of wide-necked bifurcation aneurysms while preserving adjacent branches, without necessitating dual stent implantation. This study aimed to assess the safety and effectiveness of the Barrel VRD at 12-month follow-up. The Barrel VRD trial is a prospective, multicenter, observational post-marketing registry evaluating the use of the Barrel VRD for treatment of wide-necked bifurcation aneurysms. The primary effectiveness endpoint was successful aneurysm treatment measured by digital subtraction angiography with a Raymond-Roy occlusion grade of 1 or 2 in the absence of retreatment, parent artery stenosis (>50%), or target aneurysm rupture at 12 months. The primary safety endpoint was the absence of neurological death or major stroke at 12 months. Twenty patients were enrolled from December 2013 to December 2014. The device was implanted in 19 patients with 19 aneurysms (8 middle cerebral artery, 4 anterior communicating artery, 1 internal carotid artery terminus, 4 basilar artery aneurysms; mean dome height 5.7±1.91 mm; mean neck length 4.8±1.35 mm, mean dome-to-neck ratio 1.6±2.0). Coiling was performed in all cases. The primary effectiveness endpoint was achieved in 78.9% of subjects (15/19; 12 complete occlusions, 3 neck remnants), and the primary safety endpoint was 5.3% (1/19). This prospective study demonstrates that the Barrel VRD device resulted in ~80% occlusion rates and ~5% rates of neurological complications at 1 year after endovascular treatment of wide-necked bifurcation intracranial aneurysms. REGISTERED CLINICAL TRIAL: NCT02125097;Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Y stenting assisted coiling using a new low profile visible intraluminal support device for wide necked basilar tip aneurysms: a technical report.

    Science.gov (United States)

    Conrad, Marcelo D; Brasiliense, Leonardo B C; Richie, Alexa N; Hanel, Ricardo A

    2014-05-01

    Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide necked bifurcation aneurysms. This technique was first described for the treatment of basilar tip aneurysms in combination with several different devices, demonstrating encouraging results. We report the results of the first two cases of wide necked basilar tip aneurysms treated with Y stent assisted coil embolization using a new low profile visible intraluminal stent (LVIS Jr; MicroVention, Tustin, California, USA) delivered through a 0.017 inch microcatheter. We also reviewed the literature comparing other endovascular techniques (coiling alone, stent assisted coiling, and Y stent assisted coiling) for wide necked aneurysms. The LVIS Jr device offers a new option for the treatment of these challenging lesions, with clear advantages over currently available intracranial stents. Larger series and long term results are needed to confirm the applicability and durability of this technique/technology.

  6. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    International Nuclear Information System (INIS)

    Saha, Prakash; Hughes, John; Patel, Ashish S.; Donati, Tommaso; Sallam, Morad; Patel, Sanjay D.; Bell, Rachel E.; Katsanos, Konstantinos; Modarai, Bijan; Zayed, Hany A.

    2015-01-01

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities

  7. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    Energy Technology Data Exchange (ETDEWEB)

    Saha, Prakash, E-mail: prakash.2.saha@kcl.ac.uk; Hughes, John, E-mail: johnhughes387@rocketmail.com; Patel, Ashish S., E-mail: ashish.s.patel@kcl.ac.uk; Donati, Tommaso, E-mail: tommaso.donati@gstt.nhs.uk; Sallam, Morad, E-mail: morad.sallam@gstt.nhs.uk; Patel, Sanjay D., E-mail: sanjay.patel@gstt.nhs.uk; Bell, Rachel E. [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Modarai, Bijan, E-mail: bijan.modarai@kcl.ac.uk; Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  8. A computational fluid dynamics (CFD) study of WEB-treated aneurysms: Can CFD predict WEB "compression" during follow-up?

    Science.gov (United States)

    Caroff, Jildaz; Mihalea, Cristian; Da Ros, Valerio; Yagi, Takanobu; Iacobucci, Marta; Ikka, Léon; Moret, Jacques; Spelle, Laurent

    2017-07-01

    Recent reports have revealed a worsening of aneurysm occlusion between WEB treatment baseline and angiographic follow-up due to "compression" of the device. We utilized computational fluid dynamics (CFD) in order to determine whether the underlying mechanism of this worsening is flow related. We included data from all consecutive patients treated in our institution with a WEB for unruptured aneurysms located either at the middle cerebral artery or basilar tip. The CFD study was performed using pre-operative 3D rotational angiography. From digital subtraction follow-up angiographies patients were dichotomized into two groups: one with WEB "compression" and one without. We performed statistical analyses to determine a potential correlation between WEB compression and CFD inflow ratio. Between July 2012 and June 2015, a total of 22 unruptured middle cerebral artery or basilar tip aneurysms were treated with a WEB device in our department. Three patients were excluded from the analysis and the mean follow-up period was 17months. Eleven WEBs presented "compression" during follow-up. Interestingly, device "compression" was statistically correlated to the CFD inflow ratio (P=0.018), although not to aneurysm volume, aspect ratio or neck size. The mechanisms underlying the worsening of aneurysm occlusion in WEB-treated patients due to device compression are most likely complex as well as multifactorial. However, it is apparent from our pilot study that a high arterial inflow is, at least, partially involved. Further theoretical and animal research studies are needed to increase our understanding of this phenomenon. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Angle change of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms

    International Nuclear Information System (INIS)

    Cho, W.-S.; Kang, H.-S.; Kim, J.E.; Kwon, O.-K.; Oh, C.W.; Cho, Y.D.; Han, M.H.

    2014-01-01

    Aim: To investigate the angle changes of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms. Materials and methods: The adjacent parent arterial angles before and after stent-assisted coil embolization were measured in 38 patients with aneurysms of the anterior communicating artery (ACoAA) and 41 patients with bifurcation aneurysms of the middle cerebral artery (MCABA). Variables were analysed in relation to the angle changes. Results: Vascular angles of the parent arteries significantly increased by 27.8° (±18.5°) immediately after stent-assisted coil embolization in 79 cases (p < 0.001), with 25.7° (±14.8°) in ACoAA and 29.7° (±21.4°) in MCABA, respectively. In 51 (64.6%) cases with follow-up angiography (mean interval 13.5 ± 4.1 months), vascular angles increased by 27.2° (±17.1°) immediately after treatment and further increased by 20.7° (±14.3°) at the last follow-up (all p < 0.001). More acute pre-stent angles of the parent arteries correlated with greater post-stent angle changes (p = 0.006). Younger age tended to be inversely related to post-stent angle changes (p = 0.091). Conclusion: Stent placement during coil embolization induced significant changes in the aneurysm–parent artery relationship. Further study is needed to elicit the association between angle change of the parent arteries and aneurysmal stability after coil embolization

  10. Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Sedat, Jacques; Chau, Yves; Mondot, Lydiane [CHU Nice, Unite de Neurointerventionnelle, Hopital St. Roch, Nice (France); Vargas, Julian; Szapiro, Jacek; Lonjon, Michel [CH Bastia, Service de Neurochirurgie, Bastia (France)

    2009-06-15

    Coiling associated with placement of self-expandable intracranial stents has amplified the treatment of intracranial wide-necked aneurysms, but the durability of this treatment and the existence of delayed recurrence are not yet well known. The purpose of this report is to present our experience with the Neuroform Stent associated with coiling and to evaluate complications, effectiveness, and long-term results of this technique. A retrospective study of 42 patients with wide-necked cerebral aneurysms treated with the Neuroform Stent was performed. Mean aneurysm size was 11.3 mm. Mean neck size was 5.33 mm. All patients were treated with coiling and stenting. Clinical and angiographic follow-up was available in 38 patients (90.5%). The overall follow-up time ranged from 6 months to 5 years (mean, 42 months), but most of the patients (92%) had a follow-up period superior to 1 year. Successful deployment of 41 stents (97%) was obtained. Permanent procedural morbidity was observed in only one patient (2.4%). Long-term complete aneurysmal occlusion was obtained in 27 patients (71%). Aneurysmal regrowth was observed in four patients (9.5%) on the first control angiogram. After the first control angiogram, no delayed recanalization or regrowth was observed. During the follow-up period, there were no hemorrhagic events, no delayed thrombosis, and no stent displacement. Our results demonstrate the effectiveness of the technique, a small rate of procedural complications, and long-term tolerance of the Neuroform Stent. Despite some evidence of early aneurysmal recurrence, long-term durability of stent-assisted aneurysm occlusion is stable after the first year. (orig.)

  11. Hemodynamics Modeling and Simulation of Anterior Communicating Artery Aneurysms

    Directory of Open Access Journals (Sweden)

    Jianjun Li

    2014-07-01

    Full Text Available It is a general agreement that hemodynamics plays very important role in the initiation, growth, and rupture of cerebral aneurysms and hemodynamics in the anterior communicating artery aneurysms is considered the most complex in all cerebral aneurysms and it is difficult to find some reasonable relationship between the hemodynamics parameters and the rupture risk. In this paper, the 3D geometries of four anterior communicating artery aneurysms were generated from the CTA data and the computational models with bilateral feeding arteries for the four aneurysms were constructed. The blood flow was simulated by computational fluid dynamics software and the hemodynamics parameters such as velocity, wall shear stress, and oscillatory shear index were calculated. The following results were observed: one of the four models only needs the left feeding artery; the max normalized wall shear stress locates at the aneurysmal neck of the largest aneurysm; the max oscillatory shear index locates at the aneurysmal sac of the largest aneurysm. The conclusion was drawn that the anterior communicating artery aneurysm has higher rupture risk from the hemodynamics viewpoint if the max wall shear stress locates at the neck and the max oscillatory shear index locates at the dome.

  12. Enterprise stent-assisted coiling for wide-necked intracranial aneurysms during ultra-early (48hours) subarachnoid hemorrhage: a single-center experience in 59 consecutive patients.

    Science.gov (United States)

    Liu, Aihua; Peng, Tangming; Qian, Zenghui; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Yang, Xinjian

    2015-10-01

    Accumulated experience and improvement of stents dedicated to intracranial use have significantly widened the applicability of stent-assisted coiling (SAC) to ruptured wide-necked aneurysms. This retrospective study was designed to evaluate the safety and efficacy of SAC using the Enterprise stent for ruptured wide-necked intracranial aneurysms during ultra-early subarachnoid hemorrhage. We reviewed data from 59 consecutive patients with ruptured wide-necked aneurysms who had SAC using the Enterprise stent performed within 48hours of onset. Data collected and analyzed included: patient demographics; morphologic features of the aneurysm; treatment results and follow-up results. Clinical outcomes were evaluated by modified Rankin Scale (mRS). In all 59 cases, SAC using the Enterprise stent was performed successfully, with no significant technical difficulties. Initial angiographic results were: complete occlusion in 38 cases; near occlusion in 17; and partial occlusion in four. Angiographic follow-up of 48 patients showed that 46 (95.8%) remained stable or improved, without regrowth, while regrowth was imaged in two patients. Medium-term clinical follow-up of 54 patients (mean, 26.9months) showed that 88.9% had a good outcome (mRS: 0 in 34; 1 in eight; and 2 in six), and 11.1% poor outcomes (mRS: 3 in four; and 4 in two). Enterprise SAC is a safe and viable option for treatment of ruptured wide-necked aneurysms within 48hours of ictus. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. The LVIS Jr. microstent to assist coil embolization of wide-neck intracranial aneurysms: clinical study to assess safety and efficacy

    International Nuclear Information System (INIS)

    Moehlenbruch, M.; Herweh, C.; Behrens, L.; Jestaedt, L.; Bendszus, M.; Pham, M.; Amiri, H.; Ringleb, P.A.

    2014-01-01

    This study was aimed to assess clinical safety and efficacy of the LVIS Jr. microstent in stent-assisted coil embolization of wide-neck intracranial aneurysms. IRB approved single-center interventional clinical study in 22 patients (10 females, 12 males, mean age 55, age range 33-74 years) for the endovascular treatment of wide-neck aneurysms. After obtaining informed consent, patients were included according to the following criteria: aneurysm fundus-to-neck ratio 4 mm, and a parent vessel diameter of ≤3.5 mm. Primary end point for clinical safety was absence of death, absence of major or minor stroke, and absence of transient ischemic attack. Primary end point for treatment efficacy was complete angiographic occlusion according to the Raymond-Roy Occlusion Classification (RROC) immediately after the procedure and at follow-up after 3 and 6 months on magnetic resonance imaging (MRI). In 20/22 (91 %) of patients, the primary end point of safety was reached; in the two remaining patients, transient ischemic attack, but no permanent deficit was observed; in 16/22 (73 %), efficient occlusion (RROC1) was reached, and in 6/22 (27 %), a residual neck remained (RROC2). Single [seven with antegrade, two in crossover configuration, and four with ''first-balloon-then-stent'' (FBTS) technique] or double-stent (eight patients with Y configuration and one patient with X configuration) deployment was technically successful in all cases. Deployment of the LVIS Jr. microstent in various single- or double-stent configurations is safe and effective to assist the treatment of intracranial wide-neck aneurysms. (orig.)

  14. Dynamic renal scintigraphy of dissecting aneurysm of abdominal aorta

    International Nuclear Information System (INIS)

    Tsukamoto, Eriko; Itoh, Kazuo; Furudate, Masayori

    1990-01-01

    Dynamic renal scintigraphy on 15 patients with dissecting aneurysm of abdominal aorta extending below the renal arteries were retrospectively studied. The results were reviewed and classified into 3 types according to perfusion images and parenchymal tissue uptake: Type A--symmetric perfusion and parenchymal tissue uptake; Type B--asymmetrical perfusion and parenchymal tissue uptake; Type C--delayed perfusion of one kidney and symmetric parenchymal tissue uptake. The number of patients who showed Type A, Type B, and Type C were 3 cases, 6 cases, and 6 cases, respectively. In all Type A and 3 of Type B, perfusion of bilateral renal arteries was mainly from true lumen. In the remaining 3 cases of Type B, 2 had one renal artery obstructed with thrombus; 1 had a deformity of one kidney (the blood supply was mainly from a false lumen), suggestive of renal infarction. On the other hand, in all 6 Type C cases, the renal artery where perfusion was delayed was apparently supplied from false lumen. It is suggested in this retrospective study that the findings in Type C, where delayed perfusion of one kidney and symmetric parenchymal tissue uptake were found, were due to the presence of delayed flow through the false lumen; and therefore, specific to cases where the main blood supply of one renal artery from false lumen. (author)

  15. Quantitative comparison of hemodynamics in simulated and 3D angiography models of cerebral aneurysms by use of computational fluid dynamics.

    Science.gov (United States)

    Saho, Tatsunori; Onishi, Hideo

    2015-07-01

    In this study, we evaluated hemodynamics using simulated models and determined how cerebral aneurysms develop in simulated and patient-specific models based on medical images. Computational fluid dynamics (CFD) was analyzed by use of OpenFOAM software. Flow velocity, stream line, and wall shear stress (WSS) were evaluated in a simulated model aneurysm with known geometry and in a three-dimensional angiographic model. The ratio of WSS at the aneurysm compared with that at the basilar artery was 1:10 in simulated model aneurysms with a diameter of 10 mm and 1:18 in the angiographic model, indicating similar tendencies. Vortex flow occurred in both model aneurysms, and the WSS decreased in larger model aneurysms. The angiographic model provided accurate CFD information, and the tendencies of simulated and angiographic models were similar. These findings indicate that hemodynamic effects are involved in the development of aneurysms.

  16. Aneurysmal bone cyst of the mandibular condyle with condylar neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Hoon [Department of Biomedical Engineering, College of Medicine and Healthcare Industry Research Institute, Kyung Hee University, Seoul (Korea, Republic of); Yu, Jae Jung; Kang, Ju Han; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Biology, Kyung Hee University, Seoul (Korea, Republic of)

    2009-12-15

    Aneurysmal bone cyst (ABC) is relatively rare, non-neoplastic expansible lesion of bone. The case of a 15-year-old male with a ABC of the left mandibular condyle is presented. Panoramic radiograph showed a unilocular radiolucency with thinned coritces and a subcondylar fracture which was due to the trauma. Computed tomography (CT) revealed expansible lesion which had similar attenuation soft tissue. The patient was treated surgically including iliac crestal bone graft.

  17. Aneurysmal bone cyst of the mandibular condyle with condylar neck fracture

    International Nuclear Information System (INIS)

    Park, Jeong Hoon; Yu, Jae Jung; Kang, Ju Han; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan

    2009-01-01

    Aneurysmal bone cyst (ABC) is relatively rare, non-neoplastic expansible lesion of bone. The case of a 15-year-old male with a ABC of the left mandibular condyle is presented. Panoramic radiograph showed a unilocular radiolucency with thinned coritces and a subcondylar fracture which was due to the trauma. Computed tomography (CT) revealed expansible lesion which had similar attenuation soft tissue. The patient was treated surgically including iliac crestal bone graft.

  18. Dynamic CE-MRA for endoleak classification after endovascular aneurysm repair.

    NARCIS (Netherlands)

    Laan, M.J. van der; Bakker, C.J.; Blankensteijn, J.D.; Bartels, L.W.

    2006-01-01

    AIM: To evaluate the value of dynamic contrast enhanced magnetic resonance angiography (CE-MRA) for classification of endoleaks after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: Twenty-eight patients, between 2 days and 54 months after EVAR, were evaluated with CTA, MRI and dynamic

  19. Dynamic CE=MRA for endoleak classification after endovascular aneurysm repair

    NARCIS (Netherlands)

    van der Laan, MJ; Bakker, CJG; Blankensteijn, JD; Bartels, LW

    Aim. To evaluate the value of dynamic contrast enhanced magnetic resonance angiography (CE-MRA)for classification of endoleaks after endovascular aneurysm repair (EVAR). Materials and methods. Twenty-eight patients, between 2 days and 54 months after EVAR, were evaluated with CTA, MRI and dynamic

  20. Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization.

    Science.gov (United States)

    Liu, Jian; Jing, Linkai; Wang, Chao; Paliwal, Nikhil; Wang, Shengzhang; Zhang, Ying; Xiang, Jianping; Siddiqui, Adnan H; Meng, Hui; Yang, Xinjian

    2016-11-01

    Endovascular treatment of paraclinoid aneurysms is preferred in clinical practice. Flow alterations caused by stents and coils may affect treatment outcome. To assess hemodynamic changes following stent-assisted coil embolization (SACE) in subtotally embolized paraclinoid aneurysms with residual necks that were predisposed to recanalization. We studied 27 paraclinoid aneurysms (seven recanalized and 20 stable) treated with coils and Enterprise stents. Computational fluid dynamic simulations were performed on patient-specific aneurysm geometries using virtual stenting and porous media technology. After stent placement in 27 cases, aneurysm flow velocity decreased significantly, the reduction gradually increasing from the neck plane (11.9%), to the residual neck (12.3%), to the aneurysm dome (16.3%). Subsequent coil embolization was performed after stent placement and the hemodynamic factors decreased further and significantly at all aneurysm regions except the neck plane. In a comparison of recanalized and stable cases, univariate analysis showed no significant differences in any parameter before treatment. After stent-assisted coiling, only the reduction in area-averaged velocity at the neck plane differed significantly between recanalized (8.1%) and stable cases (20.5%) (p=0.016). Aneurysm flow velocity can be significantly decreased by stent placement and coil embolization. However, hemodynamics at the aneurysm neck plane is less sensitive to coils. Significant reduction in flow velocity at the neck plane may be an important factor in preventing recanalization of paraclinoid aneurysms after subtotal SACE. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. PIV-measured versus CFD-predicted flow dynamics in anatomically realistic cerebral aneurysm models.

    Science.gov (United States)

    Ford, Matthew D; Nikolov, Hristo N; Milner, Jaques S; Lownie, Stephen P; Demont, Edwin M; Kalata, Wojciech; Loth, Francis; Holdsworth, David W; Steinman, David A

    2008-04-01

    Computational fluid dynamics (CFD) modeling of nominally patient-specific cerebral aneurysms is increasingly being used as a research tool to further understand the development, prognosis, and treatment of brain aneurysms. We have previously developed virtual angiography to indirectly validate CFD-predicted gross flow dynamics against the routinely acquired digital subtraction angiograms. Toward a more direct validation, here we compare detailed, CFD-predicted velocity fields against those measured using particle imaging velocimetry (PIV). Two anatomically realistic flow-through phantoms, one a giant internal carotid artery (ICA) aneurysm and the other a basilar artery (BA) tip aneurysm, were constructed of a clear silicone elastomer. The phantoms were placed within a computer-controlled flow loop, programed with representative flow rate waveforms. PIV images were collected on several anterior-posterior (AP) and lateral (LAT) planes. CFD simulations were then carried out using a well-validated, in-house solver, based on micro-CT reconstructions of the geometries of the flow-through phantoms and inlet/outlet boundary conditions derived from flow rates measured during the PIV experiments. PIV and CFD results from the central AP plane of the ICA aneurysm showed a large stable vortex throughout the cardiac cycle. Complex vortex dynamics, captured by PIV and CFD, persisted throughout the cardiac cycle on the central LAT plane. Velocity vector fields showed good overall agreement. For the BA, aneurysm agreement was more compelling, with both PIV and CFD similarly resolving the dynamics of counter-rotating vortices on both AP and LAT planes. Despite the imposition of periodic flow boundary conditions for the CFD simulations, cycle-to-cycle fluctuations were evident in the BA aneurysm simulations, which agreed well, in terms of both amplitudes and spatial distributions, with cycle-to-cycle fluctuations measured by PIV in the same geometry. The overall good agreement

  2. Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study.

    Science.gov (United States)

    Vakil, P; Ansari, S A; Cantrell, C G; Eddleman, C S; Dehkordi, F H; Vranic, J; Hurley, M C; Batjer, H H; Bendok, B R; Carroll, T J

    2015-05-01

    Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (K(trans), VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K(trans) would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors. Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters (K(trans), VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K(trans) and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics. Interobserver agreement was strong as shown in regression analysis (R(2) > 0.84) and intraclass correlation (intraclass correlation coefficient >0.92), indicating that the K(trans) can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (P risk in anatomic (P = .02) and combined anatomic/clinical (P = .03) groups independent of size. We report the first evidence of dynamic contrast-enhanced MR imaging-modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K(trans) was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms. © 2015 by American Journal of Neuroradiology.

  3. Why does necking ignore notches in dynamic tension?

    Directory of Open Access Journals (Sweden)

    Rotbaum Y.

    2015-01-01

    Full Text Available Recent experimental work has revealed that necking of tensile specimens, subjected to dynamic loading, is a deterministic phenomenon, governed by the applied boundary conditions. Furthermore it was shown that the potential sited, dictated by the boundary conditions, may prevail even in the presence of a notch, thus necking may occur away of the notched region. The present paper combines experimental and numerical work to address this issue. Specifically, it is shown that the dynamic tensile failure locus is dictated by both the applied velocity boundary condition and the material mechanical properties, specifically strain-rate sensitivity and strain-rate hardening. It is shown that at sufficiently high impact velocities, the flows stress in the notch vicinity becomes quite higher than in the rest of the specimen, so that while the former resists deformation, it transfers the load to the latter, resulting in the formation of a local neck and failure away from the notch. Small local perturbations in the material properties are shown to be sufficient to stabilize the structure under local failure until a neck forms elsewhere. While the physical observations are quite counterintuitive with respect to the engineering views of stress concentrator's effect, the present work rationalizes those observations and also provides information for the designers of dynamically tensioned structures that may contain notches or similar flaws.

  4. Development of a static bioactive stent prototype and dynamic aneurysm-on-a-chip(TM) model for the treatment of aneurysms

    Science.gov (United States)

    Reece, Lisa M.

    Aneurysms are pockets of blood that collect outside blood vessel walls forming dilatations and leaving arterial walls very prone to rupture. Current treatments include: (1) clipping, and (2) coil embolization, including stent-assisted coiling. While these procedures can be effective, it would be advantageous to design a biologically active stent, modified with magnetic stent coatings, allowing cells to be manipulated to heal the arterial lining. Further, velocity, pressure, and wall shear stresses aid in the disease development of aneurysmal growth, but the shear force mechanisms effecting wound closure is elusive. Due to these factors, there is a definite need to cultivate a new stent device that will aid in healing an aneurysm in situ. To this end, a static bioactive stent device was synthesized. Additionally, to study aneurysm pathogenesis, a lab-on-a-chip device (a dynamic stent device) is the key to discovering the underlying mechanisms of these lesions. A first step to the reality of a true bioactive stent involves the study of cells that can be tested against the biomaterials that constitute the stent itself. The second step is to test particles/cells in a microfluidic environment. Therefore, biocompatability data was collected against PDMS, bacterial nanocellulose (BNC), and magnetic bacterial nanocellulose (MBNC). Preliminary static bioactive stents were synthesized whereby BNC was grown to cover standard nitinol stents. In an offshoot of the original research, a two-dimensional microfluidic model, the Aneurysm-on-a-ChipTM (AOC), was the logical answer to study particle flow within an aneurysm "sac" - this was the dynamic bioactive stent device. The AOC apparatus can track particles/cells when it is coupled to a particle image velocimetry software (PIV) package. The AOC fluid flow was visualized using standard microscopy techniques with commercial microparticles/cells. Movies were taken during fluid flow experiments and PIV was utilized to monitor.

  5. Blood flow in cerebral aneurysms: comparison of phase contrast magnetic resonance and computational fluid dynamics - preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Karmonik, C.; Benndorf, G. [The Methodist Hospital Research Inst., Houston (United States). Radiology; Klucznik, R. [The Methodist Hospital, Houston (United States). Radiology

    2008-03-15

    Purpose: computational fluid dynamics (CFD) simulations are increasingly used to model cerebral aneurysm hemodynamics. We investigated the capability of phase contrast magnetic resonance imaging (pcMRI), guided by specialized software for optimal slice definition (NOVA, Vassol Inc.) as a non-invasive method to measure intra-aneurysmal blood flow patterns in-vivo. In a novel approach, these blood flow patterns measured with pcMRI were qualitatively compared to the ones calculated with CFD. Materials end methods: the volumetric inflow rates into three unruptured cerebral aneurysms and the temporal variations of the intra-aneurysmal blood flow patterns were recorded with pcMRI. Transient CFD simulations were performed on geometric models of these aneurysms derived from 3D digital subtraction angiograms. Calculated intra-aneurysmal blood flow patterns were compared at the times of maximum and minimum arterial inflow to the ones measured with pcMRI and the temporal variations of these patterns during the cardiac cycle were investigated. Results: in all three aneurysms, the main features of intra-aneurysmal flow patterns obtained with pcMRI consisted of areas with positive velocities components and areas with negative velocities components. The measured velocities ranged from approx. {+-}60 to {+-}100 cm/sec. Comparison with calculated CFD simulations showed good correlation with regard to the spatial distribution of these areas, while differences in calculated magnitudes of velocities were found. (orig.)

  6. Blood flow in cerebral aneurysms: comparison of phase contrast magnetic resonance and computational fluid dynamics - preliminary experience

    International Nuclear Information System (INIS)

    Karmonik, C.; Benndorf, G.; Klucznik, R.

    2008-01-01

    Purpose: computational fluid dynamics (CFD) simulations are increasingly used to model cerebral aneurysm hemodynamics. We investigated the capability of phase contrast magnetic resonance imaging (pcMRI), guided by specialized software for optimal slice definition (NOVA, Vassol Inc.) as a non-invasive method to measure intra-aneurysmal blood flow patterns in-vivo. In a novel approach, these blood flow patterns measured with pcMRI were qualitatively compared to the ones calculated with CFD. Materials end methods: the volumetric inflow rates into three unruptured cerebral aneurysms and the temporal variations of the intra-aneurysmal blood flow patterns were recorded with pcMRI. Transient CFD simulations were performed on geometric models of these aneurysms derived from 3D digital subtraction angiograms. Calculated intra-aneurysmal blood flow patterns were compared at the times of maximum and minimum arterial inflow to the ones measured with pcMRI and the temporal variations of these patterns during the cardiac cycle were investigated. Results: in all three aneurysms, the main features of intra-aneurysmal flow patterns obtained with pcMRI consisted of areas with positive velocities components and areas with negative velocities components. The measured velocities ranged from approx. ±60 to ±100 cm/sec. Comparison with calculated CFD simulations showed good correlation with regard to the spatial distribution of these areas, while differences in calculated magnitudes of velocities were found. (orig.)

  7. Lambda attachment in fission: a probe of the necking dynamics

    International Nuclear Information System (INIS)

    Nifenecker, H.; Malek, F.

    1991-02-01

    A schematic scission model is applied to the lambda attachment function recently obtained by the LEAR PS177 collaboration, in their measurement of the prompt fission of hypernuclei. The relationship between the slope parameter and the fission dynamics was examined in a more quantitative way. It is shown that the attachment function is sensitive to the scission configuration, necking dynamics and nuclear temperature at scission. It provides a new and powerful way to study the nuclear scission process. (R.P.) 19 refs., 9 figs

  8. CFD: computational fluid dynamics or confounding factor dissemination? The role of hemodynamics in intracranial aneurysm rupture risk assessment.

    Science.gov (United States)

    Xiang, J; Tutino, V M; Snyder, K V; Meng, H

    2014-10-01

    Image-based computational fluid dynamics holds a prominent position in the evaluation of intracranial aneurysms, especially as a promising tool to stratify rupture risk. Current computational fluid dynamics findings correlating both high and low wall shear stress with intracranial aneurysm growth and rupture puzzle researchers and clinicians alike. These conflicting findings may stem from inconsistent parameter definitions, small datasets, and intrinsic complexities in intracranial aneurysm growth and rupture. In Part 1 of this 2-part review, we proposed a unifying hypothesis: both high and low wall shear stress drive intracranial aneurysm growth and rupture through mural cell-mediated and inflammatory cell-mediated destructive remodeling pathways, respectively. In the present report, Part 2, we delineate different wall shear stress parameter definitions and survey recent computational fluid dynamics studies, in light of this mechanistic heterogeneity. In the future, we expect that larger datasets, better analyses, and increased understanding of hemodynamic-biologic mechanisms will lead to more accurate predictive models for intracranial aneurysm risk assessment from computational fluid dynamics. © 2014 by American Journal of Neuroradiology.

  9. Early-Dynamic Positron Emission Tomography (PET)/Computed Tomography and PET Angiography for Endoleak Detection After Endovascular Aneurysm Repair.

    Science.gov (United States)

    Drescher, Robert; Gühne, Falk; Freesmeyer, Martin

    2017-06-01

    To propose a positron emission tomography (PET)/computed tomography (CT) protocol including early-dynamic and late-phase acquisitions to evaluate graft patency and aneurysm diameter, detect endoleaks, and rule out graft or vessel wall inflammation after endovascular aneurysm repair (EVAR) in one examination without intravenous contrast medium. Early-dynamic PET/CT of the endovascular prosthesis is performed for 180 seconds immediately after intravenous injection of F-18-fluorodeoxyglucose. Data are reconstructed in variable time frames (time periods after tracer injection) to visualize the arterial anatomy and are displayed as PET angiography or fused with CT images. Images are evaluated in view of vascular abnormalities, graft configuration, and tracer accumulation in the aneurysm sac. Whole-body PET/CT is performed 90 to 120 minutes after tracer injection. This protocol for early-dynamic PET/CT and PET angiography has the potential to evaluate vascular diseases, including the diagnosis of complications after endovascular procedures.

  10. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI

    International Nuclear Information System (INIS)

    Isoda, Haruo; Takeda, Hiroyasu; Yamashita, Shuhei; Takehara, Yasuo; Sakahara, Harumi; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Hiramatsu, Hisaya; Namba, Hiroki; Alley, Marcus T.; Bammer, Roland; Pelc, Norbert J.

    2010-01-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall. (orig.)

  11. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI.

    Science.gov (United States)

    Isoda, Haruo; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Takeda, Hiroyasu; Hiramatsu, Hisaya; Yamashita, Shuhei; Takehara, Yasuo; Alley, Marcus T; Bammer, Roland; Pelc, Norbert J; Namba, Hiroki; Sakahara, Harumi

    2010-10-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall.

  12. Progressive Occlusion of Enterprise Stent-Assisted Coiling of Ruptured Wide-Necked Intracranial Aneurysms and Related Factors on Angiographic Follow-Up: A Single-Center Experience with 468 Patients

    Science.gov (United States)

    Liu, Aihua; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue

    2014-01-01

    This study was designed to assess the effect of the Enterprise stent on progressive occlusion of wide-necked aneurysms and to evaluate the association between dubious factors and progressive occlusion, which is a consecutive, retrospective, single-center study. Data from 468 patients with 495 wide-necked aneurysms, who had undergone Enterprise stent-assisted coiling (SAC) were reviewed, and the clinical outcomes and the angiographic results were analyzed. A 14-month clinical follow-up was achieved in 421 of the 468 patients (90.0%), showing modified Rankin Scale (mRS) 0–1 in 364 (86.4%), mRS 2 in 17 (4.1%), mRS 3 in 17 (4.1%), mRS 4–5 in 9 (2.1%), and mRS 6 in 14 (3.3%) patients. Overall, the morbidity and mortality were 10.2% and 3.3%, respectively. Initial angiographic results showed Raymond scale (RS)1 in 273 (55.2%), RS2 in 194 (39.2%), and RS3 in 28 (5.6%) patients. Eight-month angiographic follow-up was available in 394 of 495 patients (79.6%), and RS1 was seen in 315 (79.9%), RS2 in 65 (16.5%) and RS3 in 14 (3.6%) cases. At the end of the follow-up, 115 of the 165 (69.7%) patients with initial RS2 and RS3 showed progressive occlusion. Statistical analysis showed no significant difference between progressive occlusion and age (p = 0.654), sex (p = 0.016), aneurysm diameter (p = 0.010), neck size (p = 0.124), dome-to neck ratio (DNR) (p = 0.018) and location (p = 0.001) at the time of follow-up. SAC using Enterprise stent is not only feasible for wide-necked aneurysms, but can achieve a high rate of progressive occlusion with good clinical outcomes at medium-term follow-up. Patient age and aneurysm neck size showed no associated with progressive occlusion at follow-up, while sex, aneurysm diameter, DNR and location were significantly associated with progressive occlusion. PMID:24658387

  13. Phantom-based experimental validation of computational fluid dynamics simulations on cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sun Qi; Groth, Alexandra; Bertram, Matthias; Waechter, Irina; Bruijns, Tom; Hermans, Roel; Aach, Til [Philips Research Europe, Weisshausstrasse 2, 52066 Aachen (Germany) and Institute of Imaging and Computer Vision, RWTH Aachen University, Sommerfeldstrasse 24, 52074 Aachen (Germany); Philips Research Europe, Weisshausstrasse 2, 52066 Aachen (Germany); Philips Healthcare, X-Ray Pre-Development, Veenpluis 4-6, 5684PC Best (Netherlands); Institute of Imaging and Computer Vision, RWTH Aachen University, Sommerfeldstrasse 24, 52074 Aachen (Germany)

    2010-09-15

    Purpose: Recently, image-based computational fluid dynamics (CFD) simulation has been applied to investigate the hemodynamics inside human cerebral aneurysms. The knowledge of the computed three-dimensional flow fields is used for clinical risk assessment and treatment decision making. However, the reliability of the application specific CFD results has not been thoroughly validated yet. Methods: In this work, by exploiting a phantom aneurysm model, the authors therefore aim to prove the reliability of the CFD results obtained from simulations with sufficiently accurate input boundary conditions. To confirm the correlation between the CFD results and the reality, virtual angiograms are generated by the simulation pipeline and are quantitatively compared to the experimentally acquired angiograms. In addition, a parametric study has been carried out to systematically investigate the influence of the input parameters associated with the current measuring techniques on the flow patterns. Results: Qualitative and quantitative evaluations demonstrate good agreement between the simulated and the real flow dynamics. Discrepancies of less than 15% are found for the relative root mean square errors of time intensity curve comparisons from each selected characteristic position. The investigated input parameters show different influences on the simulation results, indicating the desired accuracy in the measurements. Conclusions: This study provides a comprehensive validation method of CFD simulation for reproducing the real flow field in the cerebral aneurysm phantom under well controlled conditions. The reliability of the CFD is well confirmed. Through the parametric study, it is possible to assess the degree of validity of the associated CFD model based on the parameter values and their estimated accuracy range.

  14. Wall Shear Stress Estimation of Thoracic Aortic Aneurysm Using Computational Fluid Dynamics

    Directory of Open Access Journals (Sweden)

    J. Febina

    2018-01-01

    Full Text Available An attempt has been made to evaluate the effects of wall shear stress (WSS on thoracic aortic aneurysm (TAA using Computational Fluid Dynamics (CFD. Aneurysm is an excessive localized swelling of the arterial wall due to many physiological factors and it may rupture causing shock or sudden death. The existing imaging modalities such as MRI and CT assist in the visualization of anomalies in internal organs. However, the expected dynamic behaviour of arterial bulge under stressed condition can only be effectively evaluated through mathematical modelling. In this work, a 3D aneurysm model is reconstructed from the CT scan slices and eventually the model is imported to Star CCM+ (Siemens, USA for intensive CFD analysis. The domain is discretized using polyhedral mesh with prism layers to capture the weakening boundary more accurately. When there is flow reversal in TAA as seen in the velocity vector plot, there is a chance of cell damage causing clots. This is because of the shear created in the system due to the flow pattern. It is observed from the proposed mathematical modelling that the deteriorating WSS is an indicator for possible rupture and its value oscillates over a cardiac cycle as well as over different stress conditions. In this model, the vortex formation pattern and flow reversals are also captured. The non-Newtonian model, including a pulsatile flow instead of a steady average flow, does not overpredict the WSS (15.29 Pa compared to 16 Pa for the Newtonian model. Although in a cycle the flow behaviour is laminar-turbulent-laminar (LTL, utilizing the non-Newtonian model along with LTL model also overpredicted the WSS with a value of 20.1 Pa. The numerical study presented here provides good insight of TAA using a systematic approach to numerical modelling and analysis.

  15. Phantom-based experimental validation of computational fluid dynamics simulations on cerebral aneurysms

    International Nuclear Information System (INIS)

    Sun Qi; Groth, Alexandra; Bertram, Matthias; Waechter, Irina; Bruijns, Tom; Hermans, Roel; Aach, Til

    2010-01-01

    Purpose: Recently, image-based computational fluid dynamics (CFD) simulation has been applied to investigate the hemodynamics inside human cerebral aneurysms. The knowledge of the computed three-dimensional flow fields is used for clinical risk assessment and treatment decision making. However, the reliability of the application specific CFD results has not been thoroughly validated yet. Methods: In this work, by exploiting a phantom aneurysm model, the authors therefore aim to prove the reliability of the CFD results obtained from simulations with sufficiently accurate input boundary conditions. To confirm the correlation between the CFD results and the reality, virtual angiograms are generated by the simulation pipeline and are quantitatively compared to the experimentally acquired angiograms. In addition, a parametric study has been carried out to systematically investigate the influence of the input parameters associated with the current measuring techniques on the flow patterns. Results: Qualitative and quantitative evaluations demonstrate good agreement between the simulated and the real flow dynamics. Discrepancies of less than 15% are found for the relative root mean square errors of time intensity curve comparisons from each selected characteristic position. The investigated input parameters show different influences on the simulation results, indicating the desired accuracy in the measurements. Conclusions: This study provides a comprehensive validation method of CFD simulation for reproducing the real flow field in the cerebral aneurysm phantom under well controlled conditions. The reliability of the CFD is well confirmed. Through the parametric study, it is possible to assess the degree of validity of the associated CFD model based on the parameter values and their estimated accuracy range.

  16. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms.

    Science.gov (United States)

    Sughimoto, Koichi; Takahara, Yoshiharu; Mogi, Kenji; Yamazaki, Kenji; Tsubota, Ken'ichi; Liang, Fuyou; Liu, Hao

    2014-05-01

    Aortic aneurysms may cause the turbulence of blood flow and result in the energy loss of the blood flow, while grafting of the dilated aorta may ameliorate these hemodynamic disturbances, contributing to the alleviation of the energy efficiency of blood flow delivery. However, evaluating of the energy efficiency of blood flow in an aortic aneurysm has been technically difficult to estimate and not comprehensively understood yet. We devised a multiscale computational biomechanical model, introducing novel flow indices, to investigate a single male patient with multiple aortic aneurysms. Preoperative levels of wall shear stress and oscillatory shear index (OSI) were elevated but declined after staged grafting procedures: OSI decreased from 0.280 to 0.257 (first operation) and 0.221 (second operation). Graftings may strategically counter the loss of efficient blood delivery to improve hemodynamics of the aorta. The energy efficiency of blood flow also improved postoperatively. Novel indices of pulsatile pressure index (PPI) and pulsatile energy loss index (PELI) were evaluated to characterize and quantify energy loss of pulsatile blood flow. Mean PPI decreased from 0.445 to 0.423 (first operation) and 0.359 (second operation), respectively; while the preoperative PELI of 0.986 dropped to 0.820 and 0.831. Graftings contributed not only to ameliorate wall shear stress or oscillatory shear index but also to improve efficient blood flow. This patient-specific modeling will help in analyzing the mechanism of aortic aneurysm formation and may play an important role in quantifying the energy efficiency or loss in blood delivery.

  17. Comprehensive validation of computational fluid dynamics simulationsof in-vivo blood flow in patient-specific cerebral aneurysms

    NARCIS (Netherlands)

    Sun, Q.; Groth, A.; Aach, T.

    2012-01-01

    Purpose: Recently, image-based computational fluid dynamic (CFD) simulations have been proposed to investigate the local hemodynamics inside human cerebral aneurysms. It is suggested that the knowledge ofthe computed three-dimensional flow fields can be used to assist clinical risk assessment and

  18. Gender differences in head-neck segment dynamic stabilization during head acceleration.

    Science.gov (United States)

    Tierney, Ryan T; Sitler, Michael R; Swanik, C Buz; Swanik, Kathleen A; Higgins, Michael; Torg, Joseph

    2005-02-01

    Recent epidemiological research has revealed that gender differences exist in concussion incidence but no study has investigated why females may be at greater risk of concussion. Our purpose was to determine whether gender differences existed in head-neck segment kinematic and neuromuscular control variables responses to an external force application with and without neck muscle preactivation. Forty (20 females and 20 males) physically active volunteers participated in the study. The independent variables were gender, force application (known vs unknown), and force direction (forced flexion vs forced extension). The dependent variables were kinematic and EMG variables, head-neck segment stiffness, and head-neck segment flexor and extensor isometric strength. Statistical analyses consisted of multiple multivariate and univariate analyses of variance, follow-up univariate analyses of variance, and t-tests (P Gender differences existed in head-neck segment dynamic stabilization during head angular acceleration. Females exhibited significantly greater head-neck segment peak angular acceleration (50%) and displacement (39%) than males despite initiating muscle activity significantly earlier (SCM only) and using a greater percentage of their maximum head-neck segment muscle activity (79% peak activity and 117% muscle activity area). The head-neck segment angular acceleration differences may be because females exhibited significantly less isometric strength (49%), neck girth (30%), and head mass (43%), resulting in lower levels of head-neck segment stiffness (29%). For our subject demographic, the results revealed gender differences in head-neck segment dynamic stabilization during head acceleration in response to an external force application. Females exhibited significantly greater head-neck segment peak angular acceleration and displacement than males despite initiating muscle activity earlier (SCM only) and using a greater percentage of their maximum head-neck segment

  19. Pulsatile flow effects on the hemodynamics of intracranial aneurysms.

    Science.gov (United States)

    Le, Trung B; Borazjani, Iman; Sotiropoulos, Fotis

    2010-11-01

    High-resolution numerical simulations are carried out to systematically investigate the effect of the incoming flow waveform on the hemodynamics and wall shear stress patterns of an anatomic sidewall intracranial aneurysm model. Various wave forms are constructed by appropriately scaling a typical human waveform such that the waveform maximum and time-averaged Reynolds numbers, the Womersley number (α), and the pulsatility index (PI) are systematically varied within the human physiologic range. We show that the waveform PI is the key parameter that governs the vortex dynamics across the aneurysm neck and the flow patterns within the dome. At low PI, the flow in the dome is similar to a driven cavity flow and is characterized by a quasi-stationary shear layer that delineates the parent artery flow from the recirculating flow within the dome. At high PI, on the other hand, the flow is dominated by vortex ring formation, transport across the neck, and impingement and breakdown at the distal wall of the aneurysm dome. We further show that the spatial and temporal characteristics of the wall shear stress field on the aneurysm dome are strongly correlated with the vortex dynamics across the neck. We finally argue that the ratio between the characteristic time scale of transport by the mean flow across the neck and the time scale of vortex ring formation can be used to predict for a given sidewall aneurysm model the critical value of the waveform PI for which the hemodynamics will transition from the cavity mode to the vortex ring mode.

  20. Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics

    International Nuclear Information System (INIS)

    Isoda, Haruo; Sakahara, Harumi; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Alley, Marcus T.; Bammer, Roland; Pelc, Norbert J.; Namba, Hiroki

    2010-01-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to compare hemodynamics of intracranial aneurysms of MR fluid dynamics (MRFD) using 3D cine PC MR imaging (4D-Flow) at 1.5 T and MR-based computational fluid dynamics (CFD). 4D-Flow was performed for five intracranial aneurysms by a 1.5 T MR scanner. 3D TOF MR angiography was performed for geometric information. The blood flow in the aneurysms was modeled using CFD simulation based on the finite element method. We used MR angiographic data as the vascular models and MR flow information as boundary conditions in CFD. 3D velocity vector fields, 3D streamlines, shearing velocity maps, wall shear stress (WSS) distribution maps and oscillatory shear index (OSI) distribution maps were obtained by MRFD and CFD and were compared. There was a moderate to high degree of correlation in 3D velocity vector fields and a low to moderate degree of correlation in WSS of aneurysms between MRFD and CFD using regression analysis. The patterns of 3D streamlines were similar between MRFD and CFD. The small and rotating shearing velocities and higher OSI were observed at the top of the spiral flow in the aneurysms. The pattern and location of shearing velocity in MRFD and CFD were similar. The location of high oscillatory shear index obtained by MRFD was near to that obtained by CFD. MRFD and CFD of intracranial aneurysms correlated fairly well. (orig.)

  1. Microsurgical treatment of carotid-ophthalmic aneurysm associated with multiple anterior and posterior circulation aneurysms

    Science.gov (United States)

    Wang, Jiantao; Kan, Zhisheng; Wang, Shuo

    2017-01-01

    Abstract Background: The clipping of multiple intracranial aneurysms in 1 stage is uncommon. In this case, we report clipping of an ophthalmic aneurysm associated with multiple anterior and posterior circulation aneurysms via the Dolenc approach. Methods: The main symptoms of the patient are headache, along with nausea and vomiting. The patient's arteriogram revealed a wide-necked aneurysm of the right ophthalmic artery, an irregular aneurysm of the anterior communicating artery, and a basilar artery aneurysm. The surgical intervention for these aneurysms is a challenge because of the complex anatomical relationship with the surrounding structures. The 3 aneurysms, which were not amenable to a single intervention, were successfully clipped in 1 incision. Results: After surgery, the patient reported feeling well. One year after surgery, the patient had no SAH recurrence. Conclusions: Occasionally, surgical treatment was used even for aneurysms of the carotid-ophthalmic artery with aneurysms of anterior communicating artery and basilar artery, which are contraindicated for interventional therapy. PMID:28422878

  2. Computational Fluid Dynamics: Hemodynamic Changes in Abdominal Aortic Aneurysm After Stent-Graft Implantation

    International Nuclear Information System (INIS)

    Frauenfelder, Thomas; Lotfey, Mourad; Boehm, Thomas; Wildermuth, Simon

    2006-01-01

    The aim of this study was to demonstrate quantitatively and qualitatively the hemodynamic changes in abdominal aortic aneurysms (AAA) after stent-graft placement based on multidetector CT angiography (MDCT-A) datasets using the possibilities of computational fluid dynamics (CFD). Eleven patients with AAA and one patient with left-side common iliac aneurysm undergoing MDCT-A before and after stent-graft implantation were included. Based on the CT datasets, three-dimensional grid-based models of AAA were built. The minimal size of tetrahedrons was determined for grid-independence simulation. The CFD program was validated by comparing the calculated flow with an experimentally generated flow in an identical, anatomically correct silicon model of an AAA. Based on the results, pulsatile flow was simulated. A laminar, incompressible flow-based inlet condition, zero traction-force outlet boundary, and a no-slip wall boundary condition was applied. The measured flow volume and visualized flow pattern, wall pressure, and wall shear stress before and after stent-graft implantation were compared. The experimentally and numerically generated streamlines are highly congruent. After stenting, the simulation shows a reduction of wall pressure and wall shear stress and a more equal flow through both external iliac arteries after stenting. The postimplantation flow pattern is characterized by a reduction of turbulences. New areas of high pressure and shear stress appear at the stent bifurcation and docking area. CFD is a versatile and noninvasive tool to demonstrate changes of flow rate and flow pattern caused by stent-graft implantation. The desired effect and possible complications of a stent-graft implantation can be visualized. CFD is a highly promising technique and improves our understanding of the local structural and fluid dynamic conditions for abdominal aortic stent placement

  3. Laparo- and thoracoscopic aortic aneurysm neck optimization and treatment of potential endoleaks type IA and II in a porcine model

    DEFF Research Database (Denmark)

    Kloster, Brian Ozeraitis; Lund, Lars; Lindholt, Jes S.

    2016-01-01

    , externally placed collars/aneuwraps around the proximal AAA neck and just below the left subclavian artery and division of the aortic side branches were carried out laparo-and thoracoscopically. Results: For the laparoscopic and thoracoscopic procedures respectively, mean operative time was 143 ± 41 min...

  4. Shape-memory polymer foam device for treating aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, Jason M.; Benett, William J.; Small, Ward; Wilson, Thomas S.; Maitland, Duncan J; Hartman, Jonathan

    2017-05-30

    A system for treating an aneurysm in a blood vessel or vein, wherein the aneurysm has a dome, an interior, and a neck. The system includes a shape memory polymer foam in the interior of the aneurysm between the dome and the neck. The shape memory polymer foam has pores that include a first multiplicity of pores having a first pore size and a second multiplicity of pores having a second pore size. The second pore size is larger than said first pore size. The first multiplicity of pores are located in the neck of the aneurysm. The second multiplicity of pores are located in the dome of the aneurysm.

  5. Importance of initial stress for abdominal aortic aneurysm wall motion: Dynamic MRI validated finite element analysis

    NARCIS (Netherlands)

    Merkx, M.A.G.; Veer, van 't M.; Speelman, L.; Breeuwer, M.; Buth, J.; Vosse, van de F.N.

    2009-01-01

    Currently the transverse diameter is the primary decision criterion to assess rupture risk in patients with an abdominal aortic aneurysm (AAA). To obtain a measure for more patient-specific risk assessment, aneurysm wall stress, calculated using finite element analysis (FEA), has been evaluated in

  6. Changes of incompletely embolized aneurysm with tungsten coils : an experimental study in dogs

    International Nuclear Information System (INIS)

    Yu, In Kyu; Han, Moon Hee; Kim, Sung Hyun; Won, Hyung Jin; Chang, Kee Hyun; Yeon, Kyung Mo; Choe, Ghee Young; Kim, Sam Soo

    1999-01-01

    To evaluate changes of residual aneurysms according to the size of aneurysmal neck and thrombogenicity of a tungsten coil after incomplete embolization of experimental lateral aneurysms. Eleven experimental lateral aneurysms with different aneurysmal neck size were created in the common carotid arteries of mongrel dogs. They were then divided into narrow-neck(n=3), wide-neck(n=6) and spontaneously thrombosed control(n=2) groups. After confirmation of aneurysmal patency, incomplete embolizations of varying degrees (about 30% to near total occlusion) were performed using 5mm-diameter tungsten coils. Angiography was performed immediately before and after, and one and six weeks after embolizations. The size of residual aneurysm was measured on each angiogram. After the last angiography embolized aneurysms were excised and examined under light and electron microscopes. On angiograms obtained 6 weeks after embolization, all residual narrow neck aneurysms were completely occluded, whereas in those with a wide-neck, therre was either no change (n=4) or a slight increase in size(n=2). On light microscopy, all narrow-neck aneurysms showed total organized fibrosis while all control aneurysms and half those with a wide neck showed unorganized thrombi. The embolized group showed a higher degree of organization in the aneurysmal cavity than did the control group. Neointima formation was seen in all embolized aneurysms, but no aneurysm showed foreign body reaction. On electron microscopy, uniform thickness of plasma coatings was noted on the surface of the tungsten coils. A wide-neck residual aneurysm may persist or increase in size, while one with a narrow-neck can be thrombosed after incomplete embolization with tungsten coils in a lateral aneurym. Careful consideration might be necessary in the embolization of wide-neck aneurysms. With plasma coatings on its surface and organized fibrosis, tungsten coil can be an useful for embolization of an aneurysm

  7. Combined treatment for complex intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

  8. The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

    Directory of Open Access Journals (Sweden)

    Pankaj K. Singh

    2009-01-01

    Full Text Available Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs is widely accepted. Computational fluid dynamics (CFD is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4 which was 63% (range 0–100% of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject.

  9. Methodology for Computational Fluid Dynamic Validation for Medical Use: Application to Intracranial Aneurysm.

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert J; Varble, Nicole A; Tutino, Vincent M; Dou, Zhongwang; Siddiqui, Adnan H; Meng, Hui

    2017-12-01

    Computational fluid dynamics (CFD) is a promising tool to aid in clinical diagnoses of cardiovascular diseases. However, it uses assumptions that simplify the complexities of the real cardiovascular flow. Due to high-stakes in the clinical setting, it is critical to calculate the effect of these assumptions in the CFD simulation results. However, existing CFD validation approaches do not quantify error in the simulation results due to the CFD solver's modeling assumptions. Instead, they directly compare CFD simulation results against validation data. Thus, to quantify the accuracy of a CFD solver, we developed a validation methodology that calculates the CFD model error (arising from modeling assumptions). Our methodology identifies independent error sources in CFD and validation experiments, and calculates the model error by parsing out other sources of error inherent in simulation and experiments. To demonstrate the method, we simulated the flow field of a patient-specific intracranial aneurysm (IA) in the commercial CFD software star-ccm+. Particle image velocimetry (PIV) provided validation datasets for the flow field on two orthogonal planes. The average model error in the star-ccm+ solver was 5.63 ± 5.49% along the intersecting validation line of the orthogonal planes. Furthermore, we demonstrated that our validation method is superior to existing validation approaches by applying three representative existing validation techniques to our CFD and experimental dataset, and comparing the validation results. Our validation methodology offers a streamlined workflow to extract the "true" accuracy of a CFD solver.

  10. Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations.

    Science.gov (United States)

    Tse, Kwong Ming; Chiu, Peixuan; Lee, Heow Pueh; Ho, Pei

    2011-03-15

    Aortic dissecting aneurysm is one of the most catastrophic cardiovascular emergencies that carries high mortality. It was pointed out from clinical observations that the aneurysm development is likely to be related to the hemodynamics condition of the dissected aorta. In order to gain more insight on the formation and progression of dissecting aneurysm, hemodynamic parameters including flow pattern, velocity distribution, aortic wall pressure and shear stress, which are difficult to measure in vivo, are evaluated using numerical simulations. Pulsatile blood flow in patient-specific dissecting aneurismal aortas before and after the formation of lumenal aneurysm (pre-aneurysm and post-aneurysm) is investigated by computational fluid dynamics (CFD) simulations. Realistic time-dependent boundary conditions are prescribed at various arteries of the complete aorta models. This study suggests the helical development of false lumen around true lumen may be related to the helical nature of hemodynamic flow in aorta. Narrowing of the aorta is responsible for the massive recirculation in the poststenosis region in the lumenal aneurysm development. High pressure difference of 0.21 kPa between true and false lumens in the pre-aneurismal aorta infers the possible lumenal aneurysm site in the descending aorta. It is also found that relatively high time-averaged wall shear stress (in the range of 4-8 kPa) may be associated with tear initiation and propagation. CFD modeling assists in medical planning by providing blood flow patterns, wall pressure and wall shear stress. This helps to understand various phenomena in the development of dissecting aneurysm. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Effects of atmospheric pressure dynamics on abdominal aortic aneurysm rupture onset.

    Science.gov (United States)

    Opacic, Dragan; Ilic, Nikola; Sladojevic, Milos; Schönleitner, Patrick; Markovic, Dragan; Kostic, Dusan; Davidovic, Lazar

    2018-02-01

    The effect of atmospheric pressure (AP) on the onset of abdominal aorta aneurysm rupture (RAAA) remains an unanswered question. We have investigated the seasonal variation and the effect of AP dynamics on RAAA by analysing the largest series of intraoperatively confirmed RAAA. To realize this study we have performed a retrospective analysis of 546 patients with RAAA, operated within 503 days at the Clinic for vascular and endovascular surgery CCS between 1.1.2003 and 31.12.2012. AP data for Belgrade city were obtained from meteorological yearbooks published by the Republic Hydrometeorological Service of Serbia measured at the hydrometeorological station "Belgrade Observatory". Only patients with a residence within the extended Belgrade region, exposed to the similar AP values, were included in the analysis of the AP effect on RAAA. RAAA were observed more frequently during winter and autumn months but without significant difference in comparison to other seasons. Months with higher AP values were associated with a higher RAAA rate (p = 0.0008, R2 = 0.665). A similar trend was observed for the monthly AP variability (p = 0.0311, R2 = 0.374). Average AP values did not differ between days with and without RAAA. However, during the three and seven days periods preceding RAAA AP variability parameters were greater and AP was rising. Although these pressure differences are very small, higher AP values over longer periods of time as well as greater variability are associated with RAAA. The exact mechanism behind this association remains unclear. The postulation that low AP may precipitate RAAA based on the Laplace law should be discarded.

  12. Hemodynamic vascular biomarkers for initiation of paraclinoid internal carotid artery aneurysms using patient-specific computational fluid dynamic simulation based on magnetic resonance imaging.

    Science.gov (United States)

    Watanabe, Tomoya; Isoda, Haruo; Takehara, Yasuo; Terada, Masaki; Naito, Takehiro; Kosugi, Takafumi; Onishi, Yuki; Tanoi, Chiharu; Izumi, Takashi

    2018-05-01

    We performed computational fluid dynamics (CFD) for patients with and without paraclinoid internal carotid artery (ICA) aneurysms to evaluate the distribution of vascular biomarkers at the aneurysm initiation sites of the paraclinoid ICA. This study included 35 patients who were followed up for aneurysms using 3D time of flight (TOF) magnetic resonance angiography (MRA) and 3D cine phase-contrast MR imaging. Fifteen affected ICAs were included in group A with the 15 unaffected contralateral ICAs in group B. Thirty-three out of 40 paraclinoid ICAs free of aneurysms and arteriosclerotic lesions were included in group C. We deleted the aneurysms in group A based on the 3D TOF MRA dataset. We performed CFD based on MR data set and obtained wall shear stress (WSS), its derivatives, and streamlines. We qualitatively evaluated their distributions at and near the intracranial aneurysm initiation site among three groups. We also calculated and compared the normalized highest (nh-) WSS and nh-spatial WSS gradient (SWSSG) around the paraclinoid ICA among three groups. High WSS and SWSSG distribution were observed at and near the aneurysm initiation site in group A. High WSS and SWSSG were also observed at similar locations in group B and group C. However, nh-WSS and nh-SWSSG were significantly higher in group A than in group C, and nh-SWSSG was significantly higher in group A than in group B. Our findings indicated that nh-WSS and nh-SWSSG were good biomarkers for aneurysm initiation in the paraclinoid ICA.

  13. Influence of hemodynamic factors on rupture of intracranial aneurysms: patient-specific 3D mirror aneurysms model computational fluid dynamics simulation.

    Science.gov (United States)

    Lu, G; Huang, L; Zhang, X L; Wang, S Z; Hong, Y; Hu, Z; Geng, D Y

    2011-08-01

    Hemodynamics factors play an important role in the rupture of cerebral aneurysms. The purpose of this study was to evaluate the impact of hemodynamic factors on the rupture of the MANs with 3D reconstruction model CFD simulation. RDSA was performed in 9 pairs of intracranial MANs. Each pair was divided into ruptured and unruptured groups. The hemodynamic factors of the aneurysms and their parent arteries were compared. There was a significant difference in the WSS at peak systole between the regions of the aneurysms and their parent arteries in the ruptured group (ie, 6.49 ± 3.48 Pa versus 8.78 ± 3.57 Pa, P =.015) but not in the unruptured group (ie, 9.80 ± 4.12 Pa versus 10.17 ± 7.48 Pa, P =.678). The proportion of the low WSS area to the whole area of the aneurysms was 12.20 ± 18.08% in the ruptured group and 3.96 ± 6.91% in the unruptured group; the difference between the 2 groups was statistically significant (P =.015). The OSI was 0.0879 ± 0.0764 in the ruptured group, which was significantly higher than that of the unruptured group (ie, 0.0183 ± 0.0191, P =.008). MANs may be a useful disease model to investigate possible causes linked to ruptured aneurysms. The ruptured aneurysms manifested lower WSS compared with their parent arteries, a higher proportion of the low WSS area to the whole area of aneurysm, and higher OSI compared with the unruptured aneurysms.

  14. Brain Aneurysm

    Science.gov (United States)

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  15. Morphological parameters associated with ruptured posterior communicating aneurysms.

    Science.gov (United States)

    Ho, Allen; Lin, Ning; Charoenvimolphan, Nareerat; Stanley, Mary; Frerichs, Kai U; Day, Arthur L; Du, Rose

    2014-01-01

    The rupture risk of unruptured intracranial aneurysms is known to be dependent on the size of the aneurysm. However, the association of morphological characteristics with ruptured aneurysms has not been established in a systematic and location specific manner for the most common aneurysm locations. We evaluated posterior communicating artery (PCoA) aneurysms for morphological parameters associated with aneurysm rupture in that location. CT angiograms were evaluated to generate 3-D models of the aneurysms and surrounding vasculature. Univariate and multivariate analyses were performed to evaluate morphological parameters including aneurysm volume, aspect ratio, size ratio, distance to ICA bifurcation, aneurysm angle, vessel angles, flow angles, and vessel-to-vessel angles. From 2005-2012, 148 PCoA aneurysms were treated in a single institution. Preoperative CTAs from 63 patients (40 ruptured, 23 unruptured) were available and analyzed. Multivariate logistic regression revealed that smaller volume (p = 0.011), larger aneurysm neck diameter (0.048), and shorter ICA bifurcation to aneurysm distance (p = 0.005) were the most strongly associated with aneurysm rupture after adjusting for all other clinical and morphological variables. Multivariate subgroup analysis for patients with visualized PCoA demonstrated that larger neck diameter (p = 0.018) and shorter ICA bifurcation to aneurysm distance (p = 0.011) were significantly associated with rupture. Intracerebral hemorrhage was associated with smaller volume, larger maximum height, and smaller aneurysm angle, in addition to lateral projection, male sex, and lack of hypertension. We found that shorter ICA bifurcation to aneurysm distance is significantly associated with PCoA aneurysm rupture. This is a new physically intuitive parameter that can be measured easily and therefore be readily applied in clinical practice to aid in the evaluation of patients with PCoA aneurysms.

  16. Safety and efficacy of aneurysm treatment with WEB

    DEFF Research Database (Denmark)

    Pierot, Laurent; Costalat, Vincent; Moret, Jacques

    2016-01-01

    OBJECT WEB is an innovative intrasaccular treatment for intracranial aneurysms. Preliminary series have shown good safety and efficacy. The WEB Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) trial is a prospective European trial evaluating the safety and efficacy of WEB in wide......-neck bifurcation aneurysms. METHODS Patients with wide-neck bifurcation aneurysms for which WEB treatment was indicated were included in this multicentergood clinical practices study. Clinical data including adverse events and clinical status at 1 and 6 months were collected and independently analyzed by a medical....... RESULTS Ten European neurointerventional centers enrolled 51 patients with 51 aneurysms. Treatment with WEB was achieved in 48 of 51 aneurysms (94.1%). Adjunctive implants (coils/stents) were used in 4 of 48 aneurysms (8.3%). Thromboembolic events were observed in 9 of 51 patients (17.6%), resulting...

  17. The Computational Fluid Dynamics Rupture Challenge 2013--Phase II: Variability of Hemodynamic Simulations in Two Intracranial Aneurysms.

    Science.gov (United States)

    Berg, Philipp; Roloff, Christoph; Beuing, Oliver; Voss, Samuel; Sugiyama, Shin-Ichiro; Aristokleous, Nicolas; Anayiotos, Andreas S; Ashton, Neil; Revell, Alistair; Bressloff, Neil W; Brown, Alistair G; Chung, Bong Jae; Cebral, Juan R; Copelli, Gabriele; Fu, Wenyu; Qiao, Aike; Geers, Arjan J; Hodis, Simona; Dragomir-Daescu, Dan; Nordahl, Emily; Bora Suzen, Yildirim; Owais Khan, Muhammad; Valen-Sendstad, Kristian; Kono, Kenichi; Menon, Prahlad G; Albal, Priti G; Mierka, Otto; Münster, Raphael; Morales, Hernán G; Bonnefous, Odile; Osman, Jan; Goubergrits, Leonid; Pallares, Jordi; Cito, Salvatore; Passalacqua, Alberto; Piskin, Senol; Pekkan, Kerem; Ramalho, Susana; Marques, Nelson; Sanchi, Stéphane; Schumacher, Kristopher R; Sturgeon, Jess; Švihlová, Helena; Hron, Jaroslav; Usera, Gabriel; Mendina, Mariana; Xiang, Jianping; Meng, Hui; Steinman, David A; Janiga, Gábor

    2015-12-01

    With the increased availability of computational resources, the past decade has seen a rise in the use of computational fluid dynamics (CFD) for medical applications. There has been an increase in the application of CFD to attempt to predict the rupture of intracranial aneurysms, however, while many hemodynamic parameters can be obtained from these computations, to date, no consistent methodology for the prediction of the rupture has been identified. One particular challenge to CFD is that many factors contribute to its accuracy; the mesh resolution and spatial/temporal discretization can alone contribute to a variation in accuracy. This failure to identify the importance of these factors and identify a methodology for the prediction of ruptures has limited the acceptance of CFD among physicians for rupture prediction. The International CFD Rupture Challenge 2013 seeks to comment on the sensitivity of these various CFD assumptions to predict the rupture by undertaking a comparison of the rupture and blood-flow predictions from a wide range of independent participants utilizing a range of CFD approaches. Twenty-six groups from 15 countries took part in the challenge. Participants were provided with surface models of two intracranial aneurysms and asked to carry out the corresponding hemodynamics simulations, free to choose their own mesh, solver, and temporal discretization. They were requested to submit velocity and pressure predictions along the centerline and on specified planes. The first phase of the challenge, described in a separate paper, was aimed at predicting which of the two aneurysms had previously ruptured and where the rupture site was located. The second phase, described in this paper, aims to assess the variability of the solutions and the sensitivity to the modeling assumptions. Participants were free to choose boundary conditions in the first phase, whereas they were prescribed in the second phase but all other CFD modeling parameters were not

  18. Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.

    Science.gov (United States)

    Luo, Chao-Bao; Lai, Yen-Jun; Teng, Michael Mu-Huo; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

    2013-09-01

    Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms. Two patients with unruptured wide-neck ICA aneurysms underwent SACE. Intra-procedural forward stent migration occurred during catheterization with proximal stent dislodgement and migration into the aneurysm sac. Navigation of a second stent to bridge the aneurysm neck failed in one patient because the second stent was impeded by the dislodged stent. Using the reverse waffle cone technique, a microcatheter was navigated into the aneurysm sacs. Coils were safely detached into each aneurysm sac without any device assistance. The two wide-neck aneurysms were successfully treated with preservation of flow to the internal carotid arteries. The complication of intra-procedural distal stent migration and dislodgement, with proximal stent prolapse into an aneurysm sac, may not result in a failure to coil the aneurysm. The reverse waffle cone technique provides an effective treatment in the management of this complication. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Dynamic Geometric Analysis of the Renal Arteries and Aorta following Complex Endovascular Aneurysm Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Kim, John J; Lee, Jason T; Dalman, Ronald L; Cheng, Christopher P

    2017-08-01

    Aneurysm regression and target vessel patency during early and mid-term follow-up may be related to the effect of stent-graft configuration on the anatomy. We quantified geometry and remodeling of the renal arteries and aneurysm following fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). Twenty-nine patients (mean age, 76.8 ± 7.8 years) treated with F- or Sn-EVAR underwent computed tomography angiography at preop, postop, and follow-up. Three-dimensional geometric models of the aorta and renal arteries were constructed. Renal branch angle was defined relative to the plane orthogonal to the aorta. End-stent angle was defined as the angulation between the stent and native distal artery. Aortic volumes were computed for the whole aorta, lumen, and their difference (excluded lumen). Renal patency, reintervention, early mortality, postoperative renal impairment, and endoleak were reviewed. From preop to postop, F-renal branches angled upward, Sn-renal branches angled downward (P renals exhibited increased end-stent angulation (12 ± 15°, P renals, whereas F-renals exhibited increased end-stent angulation (5 ± 10°, P renal stent patency was 94.1% and renal impairment occurred in 2 patients (6.7%). Although F- and Sn-EVAR resulted in significant, and opposite, changes to renal branch angle, only Sn-EVAR resulted in significant end-stent angulation increase. Longitudinal geometric analysis suggests that these anatomic alterations are primarily generated early as a consequence of the procedure itself and, although persistent, they show no evidence of continued significant change during the subsequent postoperative follow-up period. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Endovascular treatment of renal aneurysms: A series of 18 cases

    International Nuclear Information System (INIS)

    Sédat, J.; Chau, Y.; Baque, J.

    2012-01-01

    Purpose: To retrospectively analyze the results and complications of the endovascular treatment of 18 renal aneurysms. Methods: From 2002 to 2011, 15 patients (aged 31–76), with 18 renal aneurysms, were admitted in our institution for treatment by embolization. Except one, all were wide-necked aneurysms. One aneurysm was treated by occluding the parent artery considering its distal location; a small-necked aneurysm was treated by simple coiling, and the remaining 16 were embolized utilizing adjunctive techniques to protect the parent artery. We analyzed the rates of technical success, complication and clinical consequence, post-operative occlusion and recurrence. Results: There was a 100% technical success rate. 15 aneurysms showed a total occlusion on the post-treatment angiogram. 2 aneurysms demonstrated neck remnants, and one had an intrasaccular residual in-flow. Two minor post-operative complications were encountered but resolved over time. No delayed clinical complications were observed and the long-term angiographic follow-up demonstrated stability of the occlusion of the target renal aneurysm with no major recurrence. Conclusion: Complications of the embolization of renal aneurysms are rare. Endovascular treatment should therefore be considered at first for the treatment of renal aneurysms.

  1. Double microcatheter technique for coiling intracranial aneurysms with unfavorable configurations

    Directory of Open Access Journals (Sweden)

    WANG Shu-yuan

    2013-03-01

    Full Text Available Background Although stent-assisted technique has been widely used clinically, it is still hard to perform coiling treatment for complicated intracranial aneurysms, including relatively wide-necked tiny aneurysms and lobulated wide-necked aneurys ms with important branch vessels arising from the neck. This study aims to investigate the feasibility and clinical results of endovascular treatment for intracranial aneurysms with unfavorable configurations by using double microcatheter technique. Methods Thirty-three cases with complicated aneurysms were treated by using double microcatheter technique from April 2008 to November 2012. The locations of these aneurysms were anterior communicating artery (7 cases, posterior communicating artery (14 cases, ophthalmic artery (3 cases, anterior choroidal artery (3 cases, origin of posterior inferior cerebellar artery (3 cases, bifurcation of middle cerebral artery (2 cases and top of basilar artery (1 case. The mean neck- to-body (width ratio was 0.80 ± 0.21 (0.53-1.33. The mean body (width-to-dome (height ratio was 1.12 ± 0.37 (0.55-2.12. The mean dome (height-to-neck ratio was 1.26 ± 0.41 (0.65-2.96. The diameter of neck ≥4 mm was seen in 7 aneurysms, neck≥height in 9 and neck ≥width in 8. Besides, there were 9 very small aneurysms (the maximum diameter≤3 mm and 13 aneurysms with important branch vessels arising from the neck. All of these aneurysms were treated with coiling by using double microcatheter technique. Results All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in 19 aneurysms, and residual filling in 14. There were some small loops protruding from the neck without influencing the blood flow in 12 cases. At discharge, according to modified Rankin Scale (mRS, 30 patients with 0-1 scores presented excellent clinical outcomes and 3 patients with 2 scores had cognitive dysfunction and moderate disability due to vasospasm

  2. Morphological and clinical risk factors for posterior communicating artery aneurysm rupture.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Fujii, Motoharu; Akaike, Gensuke; Uemura, Akihiro; Takahashi, Osamu; Niimi, Yasunari; Shinoda, Masaki

    2014-01-01

    Recent studies have shown that posterior circulation aneurysms, specifically posterior communicating artery (PCoA) aneurysms, are more likely to rupture than other aneurysms. To date, few studies have investigated the factors contributing to PCoA aneurysm rupture. The authors aimed to identify morphological and clinical characteristics predisposing to PCoA aneurysm rupture. The authors retrospectively reviewed 134 consecutive patients with PCoA aneurysms managed at their facility between July 2003 and December 2012. The authors divided patients into groups of those with aneurysmal rupture (n = 39) and without aneurysmal rupture (n = 95) and compared morphological and clinical characteristics. Morphological characteristics were mainly evaluated by 3D CT angiography and included diameter of arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery), size of the aneurysm, dome-to-neck ratio, neck direction of the aneurysmal dome around the PCoA (medial, lateral, superior, inferior, and posterior), aneurysm bleb formation, whether the PCoA was fetal type, and the existence of other intracranial unruptured aneurysm(s). Patients with ruptured PCoA aneurysms were significantly younger (a higher proportion were PCoA aneurysms showed a lateral direction of the aneurysmal dome around the PCoA, had bleb formation, and the aneurysm was > 7 mm in diameter and/or the dome-to-neck ratio was > 2.0. Multivariate logistic regression analysis showed age PCoA (OR 6.7, p = 0.0001), and bleb formation (OR 11, p PCoA aneurysm rupture. The present results demonstrated that lateral projection of a PCoA aneurysm may be related to rupture.

  3. Evaluation of the dynamic and kinematic performance of the THOR dummy: neck performance

    NARCIS (Netherlands)

    Hoofman, M.; Ratingen, M.R. van; Wismans, J.S.H.M.

    1998-01-01

    The objective of this study is to evaluate the frontal head-neck performance of the THOR neck with respect to the human frontal head-neck performance and the Hybrid-III frontal head-neck performance. For this purpose, tests were carried out with an isolated THOR and Hybrid-III-neck system on a HyGe

  4. Evaluation of the dynamic and kinematic performance of the THOR dummy : neck performance

    NARCIS (Netherlands)

    Hoofman, M.; van Ratingen, M.R.; Wismans, J.S.H.M.; Cesari, D.

    1998-01-01

    The objective of this study is to evaluate the frontal head-neck performance of the THOR neck with respect to the human frontal head-neck performance and the Hybrid-III frontal head-neck performance. For this purpose, tests were carried out with an isolated THOR and Hybrid-III head-neck system on a

  5. Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

    Science.gov (United States)

    Patel, Shivam; Usmani, Abdullah Y.; Muralidhar, K.

    2017-06-01

    Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q-function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m-2 and is lowered to the range ±0.2 N m-2 in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed.

  6. Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Patel, Shivam; Usmani, Abdullah Y; Muralidhar, K

    2017-01-01

    Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q -function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m −2 and is lowered to the range ±0.2 N m −2 in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed. (paper)

  7. Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Shivam; Usmani, Abdullah Y; Muralidhar, K, E-mail: kmurli@iitk.ac.in [Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur 208016 (India)

    2017-06-15

    Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q -function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m{sup −2} and is lowered to the range ±0.2 N m{sup −2} in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed. (paper)

  8. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  9. Endovascular coil embolization for anterior choroidal artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byung Moon; Chung, Eun Chul [Sungkyunkwan University School of Medicine, Department of Radiology, Kangbuk Samsung Hospital, Seoul (Korea); Kim, Dong Ik; Kim, Dong Joon; Suh, Sang Hyun [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Kim, Sun Yong [Ajou University College of Medicine, Department of Radiology, Suwon (Korea); Shin, Yong Sam [Ajou University College of Medicine, Department of Neurosurgery, Suwon (Korea); Park, Sung Il [Soonchunhyang University College of Medicine, Department of Radiology, Bucheon Hospital, Bucheon (Korea); Choi, Chun Sik; Won, Yu.Sam [Sungkyunkwan University School of Medicine, Department of Neurosurgery, Kangbuk Samsung Hospital, Seoul (Korea)

    2008-03-15

    We retrospectively evaluated the ischemic complications related to the anterior choroidal artery (AChA) and clinical outcome after coiling of AChA aneurysms. We included 37 patients (27 with subarachnoid hemorrhage, 10 without) harboring 38 AChA aneurysms (23 ruptured, 15 unruptured) who were treated by coiling at four institutions. Ischemic complications related to the AChA and clinical outcomes were retrospectively evaluated. Intraprocedural transient AChA occlusion occurred in five aneurysms, all of which had AChA incorporated into the aneurysm neck. Two of the five patients suffered postprocedural transient contralateral hemiparesis, but recovered completely. The remaining three patients had no postprocedural symptoms. Incidence of transient AChA occlusion was significantly higher in those aneurysms in which the AChA was incorporated into aneurysm neck (group 2) than in those in which the AChA was not incorporated (group 1). Of the 37 patients, 31 (83.8%) had good recoveries (modified Rankin scale score 0-2). Two patients died from the consequences of subarachnoid hemorrhage. During follow-up for a mean of 27 months (range 4-72 months), none of the 35 living patients re-bled. A total of 29 aneurysms in 28 patients were followed-up angiographically. Recurrences were found in 5 of the 29 aneurysms during follow-up (mean 18 months, range 6-45 months). Re-embolization achieved near complete occlusion of two recurrent aneurysms, both of which were still stable at the time of the next two follow-up angiographies. The other three recurrent aneurysms were not retreated due to the small size of the recurrences. Coiling of AChA aneurysms resulted in good outcomes without AChA-related permanent ischemic complications. Transient AChA occlusion, potentially associated with ischemic complications, was significantly more frequent in the aneurysm in which the AChA was incorporated into the aneurysm neck. (orig.)

  10. Endovascular stenting for treatment of complex intracranial aneurysms: preliminary outcome

    International Nuclear Information System (INIS)

    Huang Qinghai; Liu Jianmin; Xu Yi; Hong Bo; Zhao Wenyuan; Zhou Xiaoping

    2004-01-01

    Objective: To summarize the technique and efficiency of combined endovascular stenting and Guglielmi detachable coils (GDC) packing for the treatment of intracranial wide-necked bifurcation aneurysms and recanalized aneurysms. Methods: The coronary stents were implanted across the necks of 5 intracranial wide-necked aneurysms (two at bifurcation of ICA, one at basilar artery and two recanalized PcoA aneurysms). The porous stents covered the ostia of vital side branches and perforating vessels in three cases. Microcatheters were introduced into the aneurysmal sac through the stent mesh and then followed by GDCs embolizing the aneurysms. Results: The stents were deployed in parent artery in all cases. Total occlusion was obtained in 4 cases, while more than 90% in one case with patency of the parent arteries and vital perforating arteries. Follow-up angiography performed in all patients 3-6 months later revealed no intrastent stenosis. All the patients recovered well except III nerve palsy in one patient which diminished 3 months later. Conclusion: Endovaseular therapy combined stent implantation and microcoil placement maybe a valid alteration for the treatment of wide-necked bifurcation aneurysms and recanalized aneurysms, which shows promise clinical application in the future. The ostia of vital side branches covered with stents showed no effect on hemodynamics. (authors)

  11. Safety and Efficacy of Aneurysm Treatment with the WEB

    DEFF Research Database (Denmark)

    Pierot, L; Gubucz, I; Buhk, J H

    2017-01-01

    BACKGROUND AND PURPOSE: Flow disruption with the Woven EndoBridge (WEB) device is an innovative technique for the endovascular treatment of wide-neck bifurcation aneurysms. The initial version of the device (WEB Double-Layer) was evaluated in the WEB Clinical Assessment of IntraSaccular Aneurysm ...

  12. Post-Treatment Hemodynamics of a Basilar Aneurysm and Bifurcation

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, J; Hartman, J; Rodriguez, J; Maitland, D

    2008-01-16

    Aneurysm re-growth and rupture can sometimes unexpectedly occur following treatment procedures that were initially considered to be successful at the time of treatment and post-operative angiography. In some cases, this can be attributed to surgical clip slippage or endovascular coil compaction. However, there are other cases in which the treatment devices function properly. In these instances, the subsequent complications are due to other factors, perhaps one of which is the post-treatment hemodynamic stress. To investigate whether or not a treatment procedure can subject the parent artery to harmful hemodynamic stresses, computational fluid dynamics simulations are performed on a patient-specific basilar aneurysm and bifurcation before and after a virtual endovascular treatment. The simulations demonstrate that the treatment procedure produces a substantial increase in the wall shear stress. Analysis of the post-treatment flow field indicates that the increase in wall shear stress is due to the impingement of the basilar artery flow upon the aneurysm filling material and to the close proximity of a vortex tube to the artery wall. Calculation of the time-averaged wall shear stress shows that there is a region of the artery exposed to a level of wall shear stress that can cause severe damage to endothelial cells. The results of this study demonstrate that it is possible for a treatment procedure, which successfully excludes the aneurysm from the vascular system and leaves no aneurysm neck remnant, to elevate the hemodynamic stresses to levels that are injurious to the immediately adjacent vessel wall.

  13. Aneurysm Repair

    Science.gov (United States)

    ... the aneurysm. The stent graft acts as a barrier between the blood and the diseased wall of ... Search THI Resources Office of Research Administration Library & Learning Resource Center Scientific Publications & Grants Visual Communications & Public ...

  14. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    International Nuclear Information System (INIS)

    Cil, Barbaros E.; Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-01-01

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions

  15. Hemodynamic response during aneurysm clipping surgery among experienced neurosurgeons.

    Science.gov (United States)

    Bunevicius, Adomas; Bilskiene, Diana; Macas, Andrius; Tamasauskas, Arimantas

    2016-02-01

    Neurosurgery is a challenging field associated with high levels of mental stress. The goal of this study was to investigate the hemodynamic response of experienced neurosurgeons during aneurysm clipping surgery and to evaluate whether neurosurgeons' hemodynamic responses are associated with patients' clinical statuses. Four vascular neurosurgeons (all male; mean age 51 ± 10 years; post-residency experience ≥7 years) were studied during 42 aneurysm clipping procedures. Blood pressure (BP) and heart rate (HR) were assessed at rest and during seven phases of surgery: before the skin incision, after craniotomy, after dural opening, after aneurysm neck dissection, after aneurysm clipping, after dural closure and after skin closure. HR and BP were significantly greater during surgery relative to the rest situation (p ≤ 0.03). There was a statistically significant increase in neurosurgeons' HR (F [6, 41] = 10.88, p neurosurgeon experience, the difference in BP as a function of aneurysm rupture was not significant (p > 0.08). Aneurysm location, intraoperative aneurysm rupture, admission WFNS score, admission Glasgow Coma Scale scores and Fisher grade were not associated with neurosurgeons' intraoperative HR and BP (all p > 0.07). Aneurysm clipping surgery is associated with significant hemodynamic system activation among experienced neurosurgeons. The greatest HR and BP were after aneurysm neck dissection and clipping. Aneurysm location and patient clinical status were not associated with intraoperative changes of neurosurgeons' HR and BP.

  16. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  17. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    International Nuclear Information System (INIS)

    Kaushik, Abhishek; Sankaran, Balu; Varghese, Mathew

    2010-01-01

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  18. Predictors of residual flow in embolized intracranial ruptured aneurysms at early follow-up.

    Science.gov (United States)

    Serafin, Zbigniew; Strześniewski, Piotr; Beuth, Wojciech

    2014-01-01

    The possibility of recanalization and the need for retreatment are the most important drawbacks of intracranial aneurysm embolization. The purpose of the study was to prospectively analyze the results of early follow-up angiography of embolized ruptured aneurysms in an attempt to determine factors predicting the presence of residual flow. Evaluation included 72 patients with 72 aneurysms, which were followed-up 3 months after the treatment. Analysis of residual flow predictors included: age and gender, clinical state in Hunt-Hess scale, aneurysm localization, aneurysm three dimensions and volume, neck width, sac-to-neck ratio, initial result of embolization, number of coils used and the use of hydrogel coils and stents. Mean sac diameter was 6.5±3.9 mm, and mean neck width was 2.9±1.4 mm. Follow-up angiography presented residual flow in 26 aneurysms (36.1%): class 2 in 8 aneurysms (11.1%), and class 3 in 18 cases (25.0%). Stable aneurysm filling was observed in 45 cases (62.5%), progression of residual flow in 25 cases (34.7%), and regression in 2 cases (2.8%). According to ROC analysis independent predictors of residual flow were aneurysm neck diameter (AUC 0.857, 95% CI: 0.755-0.928, p<0.0001) and sac-to-neck ratio (AUC 0.817, 95% CI: 0.708-0.898, p<0.0001). Cut-off point of the ROC curve was established at 2.8 mm for neck diameter, and 1.73 for sac-to-neck ratio. Aneurysm neck diameter and sac-to-neck ratio are independently related to the residual flow in embolized ruptured aneurysms at early follow-up.

  19. Dynamic intensity-modulated non-coplanar arc radiotherapy (INCA) for head and neck cancer

    International Nuclear Information System (INIS)

    Krayenbuehl, Jerome; Davis, J. Bernard; Ciernik, I. Frank

    2006-01-01

    Background and purpose: To define the potential advantages of intensity-modulated radiotherapy (IMRT) applied using a non-coplanar dynamic arc technique for the treatment of head and neck cancer. Materials and methods: External beam radiotherapy (EBRT) was planned in ten patients with head and neck cancer using coplanar IMRT and non-coplanar arc techniques, termed intensity modulated non-coplanar arc EBRT (INCA). Planning target volumes (PTV1) of first order covered the gross tumor volume and surrounding clinical target volume treated with 68-70 Gy, whereas PTV2 covered the elective lymph nodes with 54-55 Gy using a simultaneous internal boost. Treatment plan comparison between IMRT and INCA was carried out using dose-volume histogram and 'equivalent uniform dose' (EUD). Results: INCA resulted in better dose coverage and homogeneity of the PTV1, PTV2, and reduced dose delivered to most of the organs at risk (OAR). For the parotid glands, a reduction of the mean dose of 2.9 (±2.0) Gy was observed (p 0.002), the mean dose to the larynx was reduced by 6.9 (±2.9) Gy (p 0.003), the oral mucosa by 2.4 (±1.1) Gy (p < 0.001), and the maximal dose to the spinal cord by 3.2 (±1.7) Gy (p = 0.004). The mean dose to the brain was increased by 3.0 (±1.4) Gy (p = 0.002) and the mean lung dose increased by 0.2 (±0.4) Gy (p = 0.87). The EUD suggested better avoidance of the OAR, except for the lung, and better coverage and dose uniformity were achieved with INCA compared to IMRT. Conclusion: Dose delivery accuracy with IMRT using a non-coplanar dynamic arc beam geometry potentially improves treatment of head and neck cancer

  20. Prediction of parent artery of anterior communicating artery aneurysm on CT angiography

    International Nuclear Information System (INIS)

    Chung, Jin Young; Han, Tae Il; Kim, Dae Hong; Han, Hyun Young; Kim, Hyun Jung; Song, Mun Kab

    1999-01-01

    To determine whether CT angiography can predict the parent artery of an anterior communicating aneurysm on the basis of characteristics of the aneurysm and precommunication anterior cerebral artery. Eighteen patients with anterior communication aneurysm were studied prospectively using CT angiography and conventional angiography. The parent artery of an aneurysm was predicted by evaluating aneurysm neck location, direction of aneurysm projection, and size of the precommunicating anterior cerebral artery, as seen on CT angiography. A somatom Plus-4 spiral CT scanner was used and shaded-surface display three-dimensional images were constructed. Aneurysm neck was located near the parent artery in 12 cases(66.7%), and aneurysm projection was against the parent artery in 11 cases(61.1%). The parent artery of the anterior cerebral artery was larger in 15 cases(83.3%), including ten cases of hypoplasia or agenesis of the contralateral anterior cerebral artery. In 17 of 18 aneurysms(94.4%) the parent artery seen on DSA was correctly predicted by CT angiography. The parent artery of an anterior communicating aneurysm can be predicted by evaluating aneurysm neck location, direction of aneurysm projection, and precommunicating anterior cerebral artery, as seen on CT angiography

  1. Pilot study of dynamic cine CT angiography for the evaluation of abdominal aortic aneurysms : Implications for endograft treatment

    NARCIS (Netherlands)

    Teutelink, A; Rutten, A; Muhs, BE; Olree, M; van Herwaarden, JA; de Vos, AM; Prokop, M; Moll, FL; Verhagen, HJM

    Purpose: To utilize 40-slice electrocardiographically (ECG)-gated cine computed tomographic angiography (CTA) to characterize normal aortic motion during the cardiac cycle at relevant anatomical landmarks in preoperative abdominal aortic aneurysm (AAA) patients. Methods: In 10 consecutive

  2. Magnetic Particle Imaging for High Temporal Resolution Assessment of Aneurysm Hemodynamics.

    Directory of Open Access Journals (Sweden)

    Jan Sedlacik

    Full Text Available The purpose of this work was to demonstrate the capability of magnetic particle imaging (MPI to assess the hemodynamics in a realistic 3D aneurysm model obtained by additive manufacturing. MPI was compared with magnetic resonance imaging (MRI and dynamic digital subtraction angiography (DSA.The aneurysm model was of saccular morphology (7 mm dome height, 5 mm cross-section, 3-4 mm neck, 3.5 mm parent artery diameter and connected to a peristaltic pump delivering a physiological flow (250 mL/min and pulsation rate (70/min. High-resolution (4 h long 4D phase contrast flow quantification (4D pc-fq MRI was used to directly assess the hemodynamics of the model. Dynamic MPI, MRI, and DSA were performed with contrast agent injections (3 mL volume in 3 s through a proximally placed catheter.4D pc-fq measurements showed distinct pulsatile flow velocities (20-80 cm/s as well as lower flow velocities and a vortex inside the aneurysm. All three dynamic methods (MPI, MRI, and DSA also showed a clear pulsation pattern as well as delayed contrast agent dynamics within the aneurysm, which is most likely caused by the vortex within the aneurysm. Due to the high temporal resolution of MPI and DSA, it was possible to track the contrast agent bolus through the model and to estimate the average flow velocity (about 60 cm/s, which is in accordance with the 4D pc-fq measurements.The ionizing radiation free, 4D high resolution MPI method is a very promising tool for imaging and characterization of hemodynamics in human. It carries the possibility of overcoming certain disadvantages of other modalities like considerably lower temporal resolution of dynamic MRI and limited 2D characteristics of DSA. Furthermore, additive manufacturing is the key for translating powerful pre-clinical techniques into the clinic.

  3. The Woven EndoBridge (WEB) as primary treatment for unruptured intracranial aneurysms.

    Science.gov (United States)

    van Rooij, Sanne Bt; van Rooij, Willem Jan; Peluso, Jo P; Sluzewski, Menno

    2018-01-01

    Purpose The intrasaccular flow disruptor Woven EndoBridge (WEB) device is developed for the treatment of wide-necked aneurysms without supportive devices. We used the WEB as primary treatment for unruptured aneurysms suitable for the device, regardless of neck size. Methods Between February 2015 and June 2017, 59 aneurysms in 51 patients were selectively treated with the WEB. There were 15 men and 36 women with a mean age of 59 years. Mean aneurysm size was 7.0 mm (range 3-22 mm). Of 59 aneurysms, 45 (76%) had a wide neck defined as ≥4 mm or dome-neck ratio ≤1.5. No stents or supporting balloons were used. Results Initial WEB position was judged good in all 59 unruptured aneurysms. One patient with a basilar tip aneurysm had a late thrombotic posterior cerebral artery occlusion by protrusion of the WEB over the artery. There were no procedural ruptures. Overall complication rate was 2.0% (1 of 51, 95% CI 0.01-11.3%). Imaging follow-up was available in 55 of 59 aneurysms (93%). At 3 months, 41 of 57 aneurysms (72%) were completely occluded, 12 (21%) had a neck remnant and 4 (7%) were incompletely occluded. Conclusion WEB treatment is safe and effective in selected unruptured aneurysms suitable for the device, regardless of neck size or location. There was no need for supportive devices. Three-quarters of all unruptured small aneurysms could be treated with the WEB. In our opinion, the WEB is a valuable alternative to coils, especially in wide-necked aneurysms.

  4. Aneurysm in the brain

    Science.gov (United States)

    ... gov/ency/article/001414.htm Aneurysm in the brain To use the sharing features on this page, ... aneurysm occurs in a blood vessel of the brain, it is called a cerebral, or intracranial, aneurysm. ...

  5. Brain aneurysm repair - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000123.htm Brain aneurysm repair - discharge To use the sharing features ... this page, please enable JavaScript. You had a brain aneurysm . An aneurysm is a weak area in ...

  6. Aneurysm Complications

    Science.gov (United States)

    ... Susco Chair of Research North Shore University Hospital, Brain Aneurysm Center Chair of Research The Christopher C. Getch, MD Chair of Research Carol W. Harvey Memorial Chair of Research Kristen’s Legacy of Love Chair of Research TeamCindy Alcatraz Chair of Research ...

  7. Enterprise stenting for intracranial aneurysm treatment induces dynamic and reversible age-dependent stenosis in cerebral arteries.

    Science.gov (United States)

    Gao, Bulang; Safain, Mina G; Malek, Adel M

    2015-04-01

    Although intracranial stenting has been associated with in-stent stenosis, the vascular response of cerebral vessels to the deployment of the Enterprise vascular reconstruction device is poorly defined. To evaluate the change in parent vessel caliber that ensues after Enterprise stent placement. Seventy-seven patients with 88 aneurysms were treated using Enterprise stent-assisted coil embolization and underwent high-resolution three-dimensional rotational angiography followed by three-dimensional edge-detection filtering to remove windowing-dependence measurement artifact. Orthogonal diameters and cross-sectional areas (CSAs) were measured proximal and distal on either side of the leading stent edge (points A, B), trailing stent edge (points D, E), and at mid-stent (point C). Enterprise stent deployment caused an instant increase in the parent artery CSA by 8.98% at D, which was followed 4-6 months later by significant in-stent stenosis (15.78% at A, 27.24% at B, 10.68% at C, 32.12% at D, and 28.28% at E) in the stented artery. This time-dependent phenomenon showed resolution which was complete by 12-24 months after treatment. This target vessel stenosis showed significant age dependence with greater response in the young. No flow-limiting stenosis requiring treatment was observed in this series. Use of the Enterprise stent is associated with a significant dynamic and spontaneously resolvable age-dependent in-stent stenosis. Further study is warranted on the clinical impact, if any, of this occurrence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Preoperative cerebral aneurysm assessment by three-dimensional CT angiography. Feasibility of surgery without cerebral angiography

    International Nuclear Information System (INIS)

    Kashiwagi, Shiro; Yamashita, Katsuhiro; Kato, Shoichi; Ito, Haruhide; Kurokawa, Kensuke; Watanabe, Yutaka

    1999-01-01

    The purpose of this study is to assess the capability of three-dimensional CT angiography (3D-CTA) to replace conventional catheter angiography as a preoperative examination for unruptured intracranial aneurysms. A prospective study was designed to evaluate 18 patients with 20 unruptured intracranial aneurysms (13 middle cerebral artery aneurysms, 6 anterior communicating artery aneurysms, and 1 internal carotid posterior communicating artery aneurysm) who underwent surgery. There were 12 women and 6 men with the average age of 63 years old. All patients were initially diagnosed as having intracranial aneurysms by MR angiography, followed by 3D-CTA and conventional catheter angiography for confirmation. Three experienced neurosurgeons were in charge of the operations. One of the neurosurgeons (surgeon 1) was provided with only 3D-CTA as the preoperative radiological evaluation, while the others (surgeon 2 and 3) were given through assessments with MRA, 3D-CTA, and conventional angiography. Surgeon 1 carried out the operations under careful observation by the surgeons 2 and 3. Problems encountered by the surgeon 1 during surgery were recorded. Neck clipping in 19 aneurysms and dome wrapping in 1 were successfully accomplished. All patients were discharged without complication. Surgeries went smoothly in 16 aneurysms with 3D-CTA alone. Discrepancies between the 3D-CTA findings and microsurgical anatomy were noted in 4 aneurysms: the size of the neck was overestimated in 3 aneurysms, the relationships to parent arteries were obscure in 2 aneurysms, and a perforating artery problematic to neck clipping was missed in 1 aneurysms by 3D-CTA. The results of this study support the notion that 3D-CTA can replace conventional catheter angiography as preoperative examination in the majority of regular-sized anterior circulation aneurysms. Nevertheless, surgeons should recognize and be prepared for the fact that 3D-CTA can give false impression about the aneurysm neck and

  9. Angiographic analysis of animal model aneurysms treated with novel polyurethane asymmetric vascular stent (P-AVS): feasibility study.

    Science.gov (United States)

    Ionita, Ciprian N; Dohatcu, Andreea; Sinelnikov, Andrey; Sherman, Jason; Keleshis, Christos; Paciorek, Ann M; Hoffmann, K R; Bednarek, D R; Rudin, S

    2009-01-01

    Image-guided endovascular intervention (EIGI), using new flow modifying endovascular devices for intracranial aneurysm treatment is an active area of stroke research. The new polyurethane-asymmetric vascular stent (P-AVS), a vascular stent partially covered with a polyurethane-based patch, is used to cover the aneurysm neck, thus occluding flow into the aneurysm. This study involves angiographic imaging of partially covered aneurysm orifices. This particular situation could occur when the vascular geometry does not allow full aneurysm coverage. Four standard in-vivo rabbit-model aneurysms were investigated; two had stent patches placed over the distal region of the aneurysm orifice while the other two had stent patches placed over the proximal region of the aneurysm orifice. Angiographic analysis was used to evaluate aneurysm blood flow before and immediately after stenting and at four-week follow-up. The treatment results were also evaluated using histology on the aneurysm dome and electron microscopy on the aneurysm neck. Post-stenting angiographic flow analysis revealed aneurysmal flow reduction in all cases with faster flow in the distally-covered case and very slow flow and prolonged pooling for proximal-coverage. At follow-up, proximally-covered aneurysms showed full dome occlusion. The electron microscopy showed a remnant neck in both distally-placed stent cases but complete coverage in the proximally-placed stent cases. Thus, direct flow (impingement jet) removal from the aneurysm dome, as indicated by angiograms in the proximally-covered case, was sufficient to cause full aneurysm healing in four weeks; however, aneurysm healing was not complete for the distally-covered case. These results support further investigations into the treatment of aneurysms by flow-modification using partial aneurysm-orifice coverage.

  10. Relationship between Angiographic Results and Morphology in Sidewall Intracranial Aneurysms after Stent-Assisted Coil Embolization.

    Science.gov (United States)

    Nii, Kouhei; Aikawa, Hiroshi; Tsutsumi, Masanori; Eto, Ayumu; Iko, Minoru; Sakamoto, Kimiya; Inoue, Ritsuro; Mitsutake, Takafumi; Hanada, Hayatsura; Kazekawa, Kiyoshi

    2016-03-01

    Stent-assisted coil embolization (SACE) is used to address wide-necked or complex aneurysms. However, as they may recanalize after SACE, predictors of recanalization are needed. We investigated the relationship between follow-up angiographic results and the morphology of sidewall (SW) aneurysms in patients treated by SACE. Between September 2010 and September 2014, we performed 80 SACE procedures for SW intracranial aneurysms. Angiographic findings, obtained immediately after the procedure, 3-6 months thereafter, and when aneurysmal recanalization was suspected on MR angiogram scan, were recorded. Morphologically, the SW aneurysms were classified as "outside" (OS) and "partially inside" (PI) based on the curve of the axes of the proximal or distal parent artery with respect to the aneurysmal neck. Follow-up angiographic studies on OS- and PI SW aneurysms were compared. On the initial angiograms, we classified 42 aneurysms as OS and 38 as PI. Immediately after SACE, there was no significant difference in the angiographic findings on OS and PI aneurysms. However, on follow-up angiograms, there was a significant difference in the rate of spontaneous improvement (4 of 42 [OS] versus 21 of 38 [PI], P = .001). We performed additional coil embolization to treat 3 recanalized OS aneurysms. SW aneurysms classified morphologically as PI tended to occlude progressively even after incomplete occlusion by SACE. In contrast, aneurysms classified as OS must be observed carefully after SACE. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Average arterial input function for quantitative dynamic contrast enhanced magnetic resonance imaging of neck nodal metastases

    International Nuclear Information System (INIS)

    Shukla-Dave, Amita; Lee, Nancy; Stambuk, Hilda; Wang, Ya; Huang, Wei; Thaler, Howard T; Patel, Snehal G; Shah, Jatin P; Koutcher, Jason A

    2009-01-01

    The present study determines the feasibility of generating an average arterial input function (Avg-AIF) from a limited population of patients with neck nodal metastases to be used for pharmacokinetic modeling of dynamic contrast-enhanced MRI (DCE-MRI) data in clinical trials of larger populations. Twenty patients (mean age 50 years [range 27–77 years]) with neck nodal metastases underwent pretreatment DCE-MRI studies with a temporal resolution of 3.75 to 7.5 sec on a 1.5T clinical MRI scanner. Eleven individual AIFs (Ind-AIFs) met the criteria of expected enhancement pattern and were used to generate Avg-AIF. Tofts model was used to calculate pharmacokinetic DCE-MRI parameters. Bland-Altman plots and paired Student t-tests were used to describe significant differences between the pharmacokinetic parameters obtained from individual and average AIFs. Ind-AIFs obtained from eleven patients were used to calculate the Avg-AIF. No overall significant difference (bias) was observed for the transfer constant (K trans ) measured with Ind-AIFs compared to Avg-AIF (p = 0.20 for region-of-interest (ROI) analysis and p = 0.18 for histogram median analysis). Similarly, no overall significant difference was observed for interstitial fluid space volume fraction (v e ) measured with Ind-AIFs compared to Avg-AIF (p = 0.48 for ROI analysis and p = 0.93 for histogram median analysis). However, the Bland-Altman plot suggests that as K trans increases, the Ind-AIF estimates tend to become proportionally higher than the Avg-AIF estimates. We found no statistically significant overall bias in K trans or v e estimates derived from Avg-AIF, generated from a limited population, as compared with Ind-AIFs. However, further study is needed to determine whether calibration is needed across the range of K trans . The Avg-AIF obtained from a limited population may be used for pharmacokinetic modeling of DCE-MRI data in larger population studies with neck nodal metastases. Further validation of

  12. 3D Dynamic Modeling of the Head-Neck Complex for Fast Eye and Head Orientation Movements Research

    Directory of Open Access Journals (Sweden)

    Daniel A. Sierra

    2011-01-01

    Full Text Available A 3D dynamic computer model for the movement of the head-neck complex is presented. It incorporates anatomically correct information about the diverse elements forming the system. The skeleton is considered as a set of interconnected rigid 3D bodies following the Newton-Euler laws of movement. The muscles are modeled using Enderle's linear model, which shows equivalent dynamic characteristics to Loeb's virtual muscle model. The soft tissues, namely, the ligaments, intervertebral disks, and facet joints, are modeled considering their physiological roles and dynamics. In contrast with other head and neck models developed for safety research, the model is aimed to study the neural control of the complex during fast eye and head movements, such as saccades and gaze shifts. In particular, the time-optimal hypothesis and the feedback control ones are discussed.

  13. Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.

    Science.gov (United States)

    Kamide, Tomoya; Burkhardt, Jan-Karl; Tabani, Halima; Safaee, Michael M; Lawton, Michael T

    2018-01-01

    Although most posterior communicating artery (PCoA) aneurysms can be clipped easily with excellent results, some require anterior clinoidectomy for safe and complete clipping. To review our microsurgical series of ruptured PCoA aneurysms and identify the preoperative predictors for anterior clinoidectomy during microsurgical clipping for PCoA aneurysms. Results from microsurgical clipping of 104 patients with ruptured PCoA aneurysms were reviewed retrospectively. Distances and angles were obtained from computed tomographic angiography and compared between the anterior and nonanterior clinoidectomy groups. Anterior clinoidectomy was required in 19 of the 104 cases (18%). None developed surgical complications due to anterior clinoid process (ACP) resection, including postoperative visual deficit. Univariate and multivariate analyses revealed that the distances from the ACP tip to the aneurysmal proximal neck and from the ACP line to the aneurysmal proximal neck were statistically significant predictive factors for the need of anterior clinoidectomy. Based on a receiver operating characteristic analysis, the distances from the ACP tip to the aneurysmal proximal neck PCoA aneurysm surgery, the distances from the ACP tip to the aneurysmal proximal neck and from the ACP line to the aneurysmal proximal neck were both found to be useful predictors of whether anterior clinoidectomy was required. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Transcatheter Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer

    International Nuclear Information System (INIS)

    Rautio, Riitta; Haapanen, Arto

    2007-01-01

    Our aim was to treat a clinically silent renal artery aneurysm. The patient was a 76-year-old man with elevated prostate-specific antigen and prostata biopsies with a gradus II-III adenocarcinoma who was incidentally found to have an aneurysm in his right renal artery. We performed a successful transcatheter embolization of the aneurysm using ethylene vinyl alcohol copolymer (Onyx). To avoid migration of the liquid material into the parent artery, a balloon was inflated in the orifice of the neck of the aneurysm while the liquid was injected. Five-month follow-up computed tomography (CT) imaging confirmed total occlusion of the aneurysm

  15. A refined method for creating saccular aneurysms in the rabbit

    Energy Technology Data Exchange (ETDEWEB)

    Krings, Timo [Department of Neuroradiology, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen (Germany); Department of Neurosurgery, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen (Germany); Moeller-Hartmann, Walter; Meetz, Alexander; Dreeskamp, Heiko; Stein, Klaus-Peter; Thron, Armin [Department of Neuroradiology, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen (Germany); Hans, Franz-Josef; Thiex, Ruth; Gilsbach, Joachim M. [Department of Neurosurgery, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen (Germany); Brunn, Anna [Department of Neuropathology, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen (Germany); Scherer, Kira [Department of Laboratory Animal Science, University Hospital of the University of Technology Aachen, Pauwelsstrase 30, 52057, Aachen (Germany)

    2003-07-01

    We describe a refined animal model of human intracerebral aneurysms for testing endovascular devices for interventional neuroradiological procedures. Saccular aneurysms resulting from a stump of the right common carotid artery (CCA) were created in 15 New Zealand White rabbits by intraluminal incubation of elastase that was applied to the CCA after distal ligation of the CCA and proximal occlusion of the vessel using a pliable balloon. Subsequently a microcatheter was advanced to a position cranial to the balloon and the elastase was infused under fluoroscopic guidance to avoid retrograde flow to the trachea via aberrant vessels. Contrast-enhanced (CE) MRA at 1.5 T and conventional digital subtraction angiography was performed to test for aneurysm size, morphology and neck anatomy. In all 15 animals aneurysms resulted from the stump of the right CCA, ranging in size from 2.0 to 9.9 mm (mean 6.3 mm) in craniocaudal direction, 1.0 to 5.5 mm (mean 3.8 mm) in mediolateral direction and 1.0 to 3.8 mm (mean 2.4 mm) in neck diameter. Aneurysm morphology could be adequately demonstrated using CE MRA. On histological evaluation a loss of the internal elastic lamina was noted. The described method represents an easy, reliable, and reproducible method of aneurysm creation in the rabbit in an area of high shear stress. These aneurysms can be used for testing new endovascular devices for embolization of intracranial aneurysms. (orig.)

  16. A refined method for creating saccular aneurysms in the rabbit

    International Nuclear Information System (INIS)

    Krings, Timo; Moeller-Hartmann, Walter; Meetz, Alexander; Dreeskamp, Heiko; Stein, Klaus-Peter; Thron, Armin; Hans, Franz-Josef; Thiex, Ruth; Gilsbach, Joachim M.; Brunn, Anna; Scherer, Kira

    2003-01-01

    We describe a refined animal model of human intracerebral aneurysms for testing endovascular devices for interventional neuroradiological procedures. Saccular aneurysms resulting from a stump of the right common carotid artery (CCA) were created in 15 New Zealand White rabbits by intraluminal incubation of elastase that was applied to the CCA after distal ligation of the CCA and proximal occlusion of the vessel using a pliable balloon. Subsequently a microcatheter was advanced to a position cranial to the balloon and the elastase was infused under fluoroscopic guidance to avoid retrograde flow to the trachea via aberrant vessels. Contrast-enhanced (CE) MRA at 1.5 T and conventional digital subtraction angiography was performed to test for aneurysm size, morphology and neck anatomy. In all 15 animals aneurysms resulted from the stump of the right CCA, ranging in size from 2.0 to 9.9 mm (mean 6.3 mm) in craniocaudal direction, 1.0 to 5.5 mm (mean 3.8 mm) in mediolateral direction and 1.0 to 3.8 mm (mean 2.4 mm) in neck diameter. Aneurysm morphology could be adequately demonstrated using CE MRA. On histological evaluation a loss of the internal elastic lamina was noted. The described method represents an easy, reliable, and reproducible method of aneurysm creation in the rabbit in an area of high shear stress. These aneurysms can be used for testing new endovascular devices for embolization of intracranial aneurysms. (orig.)

  17. Automatic determination of the dynamic geometry of abdominal aortic aneurysm from MR with application to wall stress simulations

    NARCIS (Netherlands)

    Putter, de S.; Breeuwer, M.; Kose, U.; Vosse, van de F.N.; Gerritsen, F.A.; Lemke, H.U.

    2005-01-01

    The current surgical intervention criterion for abdominal aortic aneurysm is based on the maximum transverse diameter of the aorta. Recent research advances indicate that a better rupture predictor may be derived from the wall stress, which can be computed with the finite element method. An

  18. Follow-up observation of intracranial aneurysms with Guglielmi detachable coil embolization

    International Nuclear Information System (INIS)

    Li Minghua; Cheng Yingsheng; Gu Binxian; Chen Junyan; Wang Wu; Xu Tao; Xu Shiding; Liu Jianmin; Xu Yi

    2002-01-01

    Objective: To evaluate the middle-long term efficacy of intracranial aneurysms with Guglielmi detachable Coil (GDC) embolization. Methods: 131 cases with 134 aneurysms were embolized with GDC. Of them, 39 aneurysms were in the anterior communication artery, 45 in the posterior communication artery, 19 in the siphon segment of internal carotid artery, 14 in the mediate cerebral artery, 3 in the anterior cerebral artery, 9 in the posterior circle and 5 in other. A wide-neck (neck > 4 mm, or aneurysm body/neck 2 = 8.643, P < 0.01. Follow-up DSA showed no change in 118 aneurysms which were a total or nearly total occlusion on post-embolization DSA. In 16 aneurysms with subtotal or partial occlusion, re-open of aneurysm showed in 9 cases, reduced in 3, no change in 4 on follow-up DSA. Conclusion: Although the recent-medium-term efficacy of intracranial aneurysms with GDC embolization is in the affirmative, a period follow-up DSA is essential, especially in aneurysms with subtotal or partial occlusion. Again, re-embolization with GDC is recommended in a re-open aneurysm

  19. Stent-assisted coil embolization of intracranial aneurysms: a single center experience.

    Science.gov (United States)

    Luo, Chao-Bao; Teng, Michael Mu-Huo; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo; Chang, Cheng-Yen

    2012-07-01

    Endovascular detachable coil embolization has become an important method in the management of intracranial aneurysms. However, coil embolization alone may fail to treat some wide-neck aneurysms. Herein, we report our experience with and outcome of stent-assisted coil embolization (SACE) of intracranial aneurysms. Over a 5-year period, a total of 59 patients diagnosed with 63 intracranial aneurysms underwent SACE. Of the total 63 aneurysms, 6 aneurysms were treated by SACE as a salvageable procedure because of coil instability after detachment. There were 17 men and 42 women enrolled in the study, with ages ranging from 24 to 86 years (mean: 60 years). We retrospectively assessed the clinical data, aneurysm characteristics, and angiographic and clinical outcomes of all patient cases. The mean aneurysm size was 9.4 mm, and the mean neck size was 5.5 mm. Clinical and angiographic follow-up exceeding 6 months were available in 51 and 40 patients, respectively. The mean clinical follow-up time was 28 months (range: 6-49 months). Successful stent deployment was found in 60 aneurysms (95%). Midterm total or subtotal angiographic aneurismal occlusion was obtained in 56 aneurysms (89%), with further thrombosis of the aneurismal sac occurring in 4 (10%). Stable coiling aneurysm was found in 24 (78%), aneurysm recurrence was observed in 5 (13%), and permanent procedural morbidity was observed in two patients (3.4%). During the follow-up period, there were no hemorrhagic events and no stent displacement. Despite a modest procedural complication rate, and some evidence of aneurismal recurrence, SACE was proved to be both effective and safe in managing wide-neck intracranial aneurysms. Our results also demonstrated the midterm durability and stability of aneurysm treated by SACE. Furthermore, SACE can be a salvageable procedure in cases with coil instability after detachment. Copyright © 2012. Published by Elsevier B.V.

  20. Interobserver variability in the assessment of aneurysm occlusion with the WEB aneurysm embolization system.

    Science.gov (United States)

    Fiorella, David; Arthur, Adam; Byrne, James; Pierot, Laurent; Molyneux, Andy; Duckwiler, Gary; McCarthy, Thomas; Strother, Charles

    2015-08-01

    The WEB (WEB aneurysm embolization system, Sequent Medical, Aliso Viejo, California, USA) is a self-expanding, nitinol, mesh device designed to achieve aneurysm occlusion after endosaccular deployment. The WEB Occlusion Scale (WOS) is a standardized angiographic assessment scale for reporting aneurysm occlusion achieved with intrasaccular mesh implants. This study was performed to assess the interobserver variability of the WOS. Seven experienced neurovascular specialists were trained to apply the WOS. These physicians independently reviewed angiographic image sets from 30 patients treated with the WEB under blinded conditions. No additional clinical information was provided. Raters graded each image according to the WOS (complete occlusion, residual neck or residual aneurysm). Final statistics were calculated using the dichotomous outcomes of complete occlusion or incomplete occlusion. The interobserver agreement was measured by the generalized κ statistic. In this series of 30 test case aneurysms, observers rated 12-17 as completely occluded, 3-9 as nearly completely occluded, and 9-11 as demonstrating residual aneurysm filling. Agreement was perfect across all seven observers for the presence or absence of complete occlusion in 22 of 30 cases. Overall, interobserver agreement was substantial (κ statistic 0.779 with a 95% CI of 0.700 to 0.857). The WOS allows a consistent means of reporting angiographic occlusion for aneurysms treated with the WEB device. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Dynamic head-neck stabilization and modulation with perturbation bandwidth investigated using a multisegment neuromuscular model

    NARCIS (Netherlands)

    Happee, R. (Riender); de Bruijn, E. (Edo); Forbes, P.A. (Patrick A.); F.C.T. van der Helm (Frans C.)

    2017-01-01

    textabstractThe human head-neck system requires continuous stabilization in the presence of gravity and trunk motion. We investigated contributions of the vestibulocollic reflex (VCR), the cervicocollic reflex (CCR), and neck muscle co-contraction to head-in-space and head-on-trunk stabilization,

  2. Dynamic head-neck stabilization and modulation with perturbation bandwidth investigated using a multisegment neuromuscular model

    NARCIS (Netherlands)

    Happee, R.; de Bruijn, E.; Forbes, P.A.; van der Helm, F.C.T.

    2017-01-01

    The human head-neck system requires continuous stabilization in the presence of gravity and trunk motion. We investigated contributions of the vestibulocollic reflex (VCR), the cervicocollic reflex (CCR), and neck muscle co-contraction to head-in-space and head-on-trunk stabilization, and

  3. Aneurysms with persistent filling after failed treatment with the Pipeline embolization device.

    Science.gov (United States)

    Daou, Badih; Atallah, Elias; Chalouhi, Nohra; Starke, Robert M; Oliver, Jeffrey; Montano, Maria; Jabbour, Pascal; Rosenwasser, Robert H; Tjoumakaris, Stavropoula I

    2018-05-04

    = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03-1.09; p < 0.001) were associated with incomplete aneurysm occlusion. CONCLUSIONS While the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.

  4. Enterprise Deployment Through PulseRider To Treat Anterior Communicating Artery Aneurysm Recurrence.

    Science.gov (United States)

    Valente, Iacopo; Limbucci, Nicola; Nappini, Sergio; Rosi, Andrea; Laiso, Antonio; Mangiafico, Salvatore

    2018-02-01

    PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a new endovascular device designed to treat wide-neck bifurcation intracranial aneurysms. Deployment of a stent through a PulseRider to treat an aneurysm's recurrence has never been described before. We report the case of a 55-year-old man who underwent coiling of an 8-mm anterior communicating artery aneurysm with assistance of a PulseRider neck reconstruction device. The 6-month digital subtraction angiography control showed aneurysm recurrence, so we deployed an Enterprise 2 closed-cell stent (Codman, Miami Lakes, Florida, USA) in the A1-A2 segment passing across the previously implanted PulseRider. Enterprise correctly expanded and allowed for adequate coiling of the aneurysm. An Enterprise stent can be safely opened through a PulseRider in order to treat aneurysm recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Endothelial cell proliferation in swine experimental aneurysm after coil embolization.

    Directory of Open Access Journals (Sweden)

    Yumiko Mitome-Mishima

    Full Text Available After coil embolization, recanalization in cerebral aneurysms adversely influences long-term prognosis. Proliferation of endothelial cells on the coil surface may reduce the incidence of recanalization and further improve outcomes after coil embolization. We aimed to map the expression of proliferating tissue over the aneurysmal orifice and define the temporal profile of tissue growth in a swine experimental aneurysm model. We compared the outcomes after spontaneous thrombosis with those of coil embolization using histological and morphological techniques. In aneurysms that we not coiled, spontaneous thrombosis was observed, and weak, easily detachable proliferating tissue was evident in the aneurysmal neck. In contrast, in the coil embolization group, histological analysis showed endothelial-like cells lining the aneurysmal opening. Moreover, immunohistochemical and morphological analysis suggested that these cells were immature endothelial cells. Our results indicated the existence of endothelial cell proliferation 1 week after coil embolization and showed immature endothelial cells in septal tissue between the systemic circulation and the aneurysm. These findings suggest that endothelial cells are lead to and proliferate in the former aneurysmal orifice. This is the first examination to evaluate the temporal change of proliferating tissue in a swine experimental aneurysm model.

  6. Towards the prediction of multiple necking during dynamic extension of round bar: linear stability approach versus finite element calculations

    International Nuclear Information System (INIS)

    Maï, S El; Petit, J; Mercier, S; Molinari, A

    2014-01-01

    The fragmentation of structures subject to dynamic conditions is a matter of interest for civil industries as well as for Defence institutions. Dynamic expansions of structures, such as cylinders or rings, have been performed to obtain crucial information on fragment distributions. Many authors have proposed to capture by FEA the experimental distribution of fragment size by introducing in the FE model a perturbation. Stability and bifurcation analyses have also been proposed to describe the evolution of the perturbation growth rate. In the proposed contribution, the multiple necking of a round bar in dynamic tensile loading is analysed by the FE method. A perturbation on the initial flow stress is introduced in the numerical model to trigger instabilities. The onset time and the dominant mode of necking have been characterized precisely and showed power law evolutions, with the loading velocities and moderately with the amplitudes and the cell sizes of the perturbations. In the second part of the paper, the development of linear stability analysis and the use of salient criteria in terms of the growth rate of perturbations enabled comparisons with the numerical results. A good correlation in terms of onset time of instabilities and of number of necks is shown.

  7. Comparison of cannulated screw and dynamic hip screw for the treatment of femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Mehmet Gem

    2015-09-01

    Full Text Available Objective: We aimed to compare the results of surgeries for intracapsular femoral neck fractures with cannulated screws(CS and dynamic hip screw(DHS, due to lack of evidence which implant for internal fixation of femoral neck fractures is better . Methods: In our clinic between September 2005 and November 2009, 38 patients were operated with intracapsular transcervical fracture of collum femoris between17 to 65 years of age. Eighteen were operated with DHS(47.4% and 20 were operated with CS fixation(52.6%. Results: 16 patients (42.1% were female and 22 (57.9% were male and the mean age was 37.13 (17-65 years. The mean duration of follow-up was 18.05 (2-57 months. 26 patients were operated in 1st -3rd day (68.4%, 9 patients were operated in 4 to 7 day (23.7%, 3 patients were operated in after 7th day (7.9%. In the DHS group, 9 (50% patients had avascular necrosis (AVN, 6 (33.3% patients had implant failure, 3 (16.7% patients had delayed union, 5 (27.8% patients had nonunion, 1 (5.6% patient had infection, and 1 (5.6% patient had myositis ossificans. According to the criteria of Salvati Wilson hip joint assessment, in the DHS group 8 patients (44.4% were very good, 5 patients (27.8% were good, 5 patients (27.8% were moderate. Salvati score was evaluated as average of 28 points (16-40. İn the CS group, 8 (40% patients had AVN, 1 (5% had delayed union, 3 (15% of the cases had nonunion and 1 (5% patients infection was detected. According to the criteria of the Salvati-Wilson, in the CS group13 (65% of them are very good, 5 (25% were good, 2 (10% were assessed as moderate. Salvati score was evaluated as average of 33 points (18-40. In the CS group none of the patients had implant failure, in the DHS group 6 patients had implant failure (33.3% (p<0,05. Conclusion: Except for the high rate of implant failure detection in the DHS group method, no significant difference between complications and functional results between two groups. J Clin Exp Invest

  8. Stent-assisted coil embolization of intracranial aneurysms: A single center experience

    Directory of Open Access Journals (Sweden)

    Chao-Bao Luo

    2012-07-01

    Conclusion: Despite a modest procedural complication rate, and some evidence of aneurismal recurrence, SACE was proved to be both effective and safe in managing wide-neck intracranial aneurysms. Our results also demonstrated the midterm durability and stability of aneurysm treated by SACE. Furthermore, SACE can be a salvageable procedure in cases with coil instability after detachment.

  9. Velocity profile and wall shear stress of saccular aneurysms at the anterior communicating artery.

    Science.gov (United States)

    Yamaguchi, Ryuhei; Ujiie, Hiroshi; Haida, Sayaka; Nakazawa, Nobuhiko; Hori, Tomokatsu

    2008-01-01

    It has recently been shown that the aspect ratio (dome/neck) of an aneurysm correlates well with intraaneurysmal blood flow. Aneurysms with an aspect ratio larger than 1.6 carry a higher risk of rupture. We examined the effect of aspect ratio (AR) on intra-aneurysmal flow using experimental models. Flow visualization with particle imaging velocimetry and measurement of wall shear stress using laser Doppler anemometry were performed on three different aneurysm models: AR 0.5, 1.0, and 2.0. Intraaneurysmal flow consists of inflow, circulation, and outflow. Rapid inflow impinged on the distal neck creating a stagnant point. Rapid flow and maximum wall shear stress were observed in the vicinity of the stagnant point. By changing the Reynold's number, the stagnant point moved. By increasing the AR of the aneurysm, vortices inside the aneurysm sac closed and very slow flow was observed, resulting in very low shear stress markedly at a Reynold's number of 250, compatible with the diastolic phase. In the aneurysm model AR 2.0, both rapid flow at the neck and vortices inside the aneurysm are sufficient to activate platelets, making a thrombus that may anchor on the dome where very slow flow takes place. Hemodynamics in aneurysms larger than AR 2.0 definitely contribute to thrombus formation.

  10. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    International Nuclear Information System (INIS)

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young; Kim, Soo Hyun; Chang, Nam Kyu

    2013-01-01

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  11. A novel flow diverter(Tubridge) for the treatment of recurrent aneurysms: A single-center experience

    International Nuclear Information System (INIS)

    Zhang, Yong Xin; Huang, Qing Hai; Fang, Yibin; Yang, Peng Fei; Xu, Yi; Hong Bo; Liu, Jian Min

    2017-01-01

    The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD. A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed. Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7–36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ≤ 2) at discharge and follow-up. In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points

  12. A novel flow diverter(Tubridge) for the treatment of recurrent aneurysms: A single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yong Xin; Huang, Qing Hai; Fang, Yibin; Yang, Peng Fei; Xu, Yi; Hong Bo; Liu, Jian Min [Dept. of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai (China)

    2017-09-15

    The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD. A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed. Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7–36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ≤ 2) at discharge and follow-up. In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points.

  13. Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136 cases.

    Science.gov (United States)

    Shi, Lei; Yu, Jing; Zhao, Ying; Xu, Kan; Yu, Jinlu

    2018-02-01

    It is widely acknowledged that arteriosclerosis and calcification of the parent artery and aneurysm neck make it difficult to clip posterior communicating artery (PCoA) aneurysms. A total of 136 cases of PCoA aneurysms accompanied by arteriosclerosis and calcification were collected and treated with clipping in the present study. Of the 136 patients, 112 were females (82.4%) and 24 were males (17.6%), with ages ranging from 37 to 76 years (mean age, 60.2 years). Rupture of a PCoA aneurysm was identified in 132 cases (97.1%), and there were 4 cases of unruptured PCoA aneurysms (2.9%). According to the severity of arteriosclerosis and calcification, the aneurysms were divided into type I, II or III. The treatment of type I aneurysms achieved the best curative effect. It is difficult to temporarily occlude type II and III aneurysms during surgery, and temporary occlusion failed in almost 50% of cases. Types II and III were prone to intraoperative aneurysm ruptures. A significantly higher rate of intraoperative aneurysm rupture was seen in type III compared with type II cases. Type II and III cases were more likely to be treated using a fenestrated clip for aneurysm clipping compared with type I cases, and fenestrated clips were used significantly more frequently in type III cases compared with type II cases. Arteriosclerosis and calcification were likely to affect the prognosis of patients, particularly in cases with type III arteriosclerosis and calcification of the parent artery and aneurysm neck. Therefore, the stratification of the arteriosclerosis and calcification of the parent artery and aneurysm neck into types I-III can guide the intraoperative aneurysm clipping strategy, aid in choosing the correct clips, and inform predictions of the occurrence of rupture and hemorrhage, as well as the prognosis for aneurysms.

  14. Cellular responses of bioabsorbable polymeric material and Guglielmi detachable coil in experimental aneurysms.

    Science.gov (United States)

    Murayama, Yuichi; Viñuela, Fernando; Tateshima, Satoshi; Gonzalez, Nestor R; Song, Joon K; Mahdavieh, Haleh; Iruela-Arispe, Luisa

    2002-04-01

    Acceleration of healing mechanisms is a promising approach to improve current limitations of endovascular aneurysm therapy with the use of platinum coils. We evaluated a new endovascular therapeutic, bioabsorbable polymeric material (BPM), which may promote cellular reaction in the aneurysms. Four different concentrations of lactide/glycolic acid copolymer [poly(D-L-lactic-co-glycolic acid)] (PLGA), 85/15, 75/25, 65/35, and 50/50, were used as BPMs. Sixteen experimental aneurysms were created in 8 swine. Eight-millimeter-long spiral-shaped BPMs were surgically implanted in the aneurysms without tight packing (n=3 for each BPM). Guglielmi detachable coils (GDCs) were used as control (n=4). The animals were killed 14 days after embolization, and angiographic, histological, and immunohistochemical analyses were performed. Despite loose packing of aneurysms with BPMs, faster BPMs such as 50/50 or 65/35 PLGA demonstrated more mature collagen formation and fibrosis in the sac and neck of the aneurysm. One aneurysm treated with 65/35 PLGA, 1 treated with 75/25 PLGA, and all 3 treated with 85/15 PLGA showed a neck remnant on angiography. There was a linear relationship between collagen levels and polymer degradation properties (r=-0.9513). This preliminary animal study indicates that acceleration of aneurysm healing with the use of BPM is feasible. This concept can be applied to decrease and perhaps prevent aneurysmal recanalization after endovascular treatment of cerebral aneurysms.

  15. The New Low-Profile WEB 17 System for Treatment of Intracranial Aneurysms: First Clinical Experiences.

    Science.gov (United States)

    van Rooij, S B T; Peluso, J P; Sluzewski, M; Kortman, H G; van Rooij, W J

    2018-05-01

    The Woven EndoBridge (WEB) is an intrasaccular flow diverter intended to treat wide-neck aneurysms. The latest generation WEBs needed a 0.021-inch microcatheter in the small sizes. Recently, a lower profile range of WEBs compliant with a 0.017-inch microcatheter (WEB 17) has been introduced. We present the first clinical results of treatment of both ruptured and unruptured aneurysms with the WEB 17. Between December 2016 and September 2017, forty-six aneurysms in 40 patients were treated with the WEB 17. No supporting stents or balloons were used. Twenty-five aneurysms were ruptured (54%). There were 6 men and 34 women (mean age, 62 years; median, 63 years; range, 46-87 years). The mean aneurysm size was 4.9 mm (median, 5 mm; range, 2-7 mm). There were 2 thromboembolic procedural complications without clinical sequelae and no ruptures. The overall permanent procedural complication rate was 0% (0 of 40; 97.5% CI, 0%-10.4%). Imaging follow-up at 3 months was available in 33 patients with 39 aneurysms (97.5% of 40 eligible aneurysms). In 1 aneurysm, the detached WEB was undersized and the remnant was additionally treated with coils after 1 week. This same aneurysm reopened at 3 months and was again treated with a second WEB. One other aneurysm showed persistent WEB filling at 3 months. Complete occlusion was achieved in 28 of 39 aneurysms (72%), and 9 aneurysms (23%) showed a neck remnant. The WEB 17 is safe and effective for both ruptured and unruptured aneurysms. The WEB 17 is a valuable addition to the existing WEB size range, especially for very small aneurysms. © 2018 by American Journal of Neuroradiology.

  16. Radiation Exposure in Endovascular Infra-Renal Aortic Aneurysm Repair and Factors that Influence It

    Directory of Open Access Journals (Sweden)

    Rui Machado

    Full Text Available Abstract Objective: The endovascular repair of aortic abdominal aneurysms exposes the patients and surgical team to ionizing radiation with risk of direct tissue damage and induction of gene mutation. This study aims to describe our standard of radiation exposure in endovascular aortic aneurysm repair and the factors that influence it. Methods: Retrospective analysis of a prospective database of patients with abdominal infra-renal aortic aneurysms submitted to endovascular repair. This study evaluated the radiation doses (dose area product (DAP, fluoroscopy durations and their relationships to the patients, aneurysms, and stent-graft characteristics. Results: This study included 127 patients with a mean age of 73 years. The mean DAP was 4.8 mGy.m2, and the fluoroscopy time was 21.8 minutes. Aortic bilateral iliac aneurysms, higher body mass index, aneurysms with diameters larger than 60 mm, necks with diameters larger than 28 mm, common iliac arteries with diameters larger than 20 mm, and neck angulations superior to 50 degrees were associated with an increased radiation dose. The number of anatomic risk factors present was associated with increased radiation exposure and fluoroscopy time, regardless of the anatomical risk factors. Conclusion: The radiation exposure during endovascular aortic aneurysm repair is significant (mean DAP 4.8 mGy.m2 with potential hazards to the surgical team and the patients. The anatomical characteristics of the aneurysm, patient characteristics, and the procedure's technical difficulty were all related to increased radiation exposure during endovascular aortic aneurysm repair procedures. Approximately 40% of radiation exposure can be explained by body mass index, neck angulation, aneurysm diameter, neck diameter, and aneurysm type.

  17. Ruptured submitral aneurysm

    Directory of Open Access Journals (Sweden)

    V. Shukla

    2016-09-01

    Full Text Available Submitral aneurysm is a rare entity, with around few hundred cases reported till date. Presentation can be varied. We describe here a case of submitral aneurysm in a young male with rupture into the left atrium cavity.

  18. Abdominal Aortic Aneurysm (AAA)

    Science.gov (United States)

    ... Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis or plaque buildup causes the ... weak and bulge outward like a balloon. An AAA develops slowly over time and has few noticeable ...

  19. Experimental Study of Flow Through Carotid Aneurysms

    Science.gov (United States)

    Masoomi, Faezeh; Mejia-Alvarez, Ricardo

    2017-11-01

    There is evidence that traditional endovascular techniques like coiling are not effective for treatment of wide-neck cerebral aneurysms. Flow Diverter Stents (FDS) have emerged as promising devices for treating complex aneurysms since they enable treatment of aneurysms that were considered untreatable before. Recent studies suggest a number of associated risks with FDS, including in-stent thrombosis, perianeurysmal edema, delayed hemorrhage, and perforator occlusions. Chong et al. simulated hemodynamic behavior using patient-specific data. From their study, it is possible to infer that the standard deviation of energy loss could be a good predictor for intervention success. The aim of this study is to investigate the flow in models of cerebral aneurysms before and after FDS insertion using PIV. These models will be based on actual clinical studies and will be fabricated with advanced additive manufacturing techniques. These data will then be used to explore flow parameters that could inform the likelihood of post-intervention aneurysm rupture, and help determine FDS designs that better suit any particular patient before its procedure.

  20. Indentification of inflow zone of cerebral aneurysm by MRA for effective coil embolization

    International Nuclear Information System (INIS)

    Kudo, Takumi; Satow, Tetsu; Yamada, Naoaki; Hyuga, Takanori; Miyamoto, Susumu; Murao, Kenichi

    2008-01-01

    It is important to pack the inflow zone of intracerebral aneurysm to prevent coil compaction or recanalization after coil embolization of the aneurysm. In this study, we report the usefulness of magnetic resonance angiography (MRA) to identify the inflow zone of the aneurysm. Between November 2004 and March 2006, 21 patients (IC paraclinoid, 11 cases; BA tip, 3 cases; A-com, 4 cases; IC-top, 2 cases; P1, 1 case) underwent interventional coil embolization for cerebral aneurysms and MRA was used to try to depict the inflow zone of the aneurysm. We designed a 3D time-of-flight MRA technique targeted to the aneurysm with a large flip angle to emphasize the streamline into the aneurysm. We grasped the position of the inflow zone in the aneurysm by MRA before intervention. The inflow zone was packed by coils tightly with balloon neck remodeling technique anchor catheter assist technique, if necessary. The inflow zone was depicted in all 21 cases by MRA. In sidewall type aneurysms, the inflow zone existed beside the distal neck in all cases. In terminal type aneurysms, the inflow zone existed on an extension line from patent artery. Dome filling was not detected in all cases after treatment. Small neck remnant was detected in 6 cases that slightly increased in 4 cases, vanished in 1 case, remained and unchanged in 1 case 6 months after treatment. None of the cases required additional treatment. For effective coil embolization, it is important to grasp the position of the inflow zone of the aneurysm and to pack the point as tightly as possible. Identification of the inflow zone of aneurysm by MRA is useful for coil embolization. (author)

  1. Application of dual volume reconstruction technique in embolization of intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xiang-hai ZHANG

    2014-03-01

    Full Text Available Objective To explore the value of dual volume reconstruction technique in Guglielmi detachable coil (GDC embolization of intracranial aneurysms. Methods Three-dimensional imaging data of 20 patients received GDC embolization of intracranial aneurysms from Jun. 2012 to Apr. 2013 were analyzed for dual volume reconstruction. The value of application of dual volume reconstruction was evaluated by the detection rate of coils bolus, degree of aneurysm occlusion, the length of aneurysm sac and aneurysm neck before and after embolization, and the characteristics and clinical value of the reconstructed images. Results  A total of 20 coil boluses were detected by dual volume reconstruction images, and the detection rate was 100%. Among all of 20 patients, no visualization of contrast medium in the aneurysm was found in 13 patients, while contrast agent was found in the aneurysm sac in 3 patients and in the aneurysm neck in 4 patients. The length of aneurysm neck and sac was somewhat changed before and after embolization with no statistically significant difference (P>0.05. The dual volume reconstruction could reveal coil bolus, vessels, cranium and fusion images, and the aneurysms could be shown by different imaging modes according to the clinical requirement. Conclusion Dual volume reconstruction technique can display the location of coil bolus, degree of occlusion and aneurysm size, and evaluate the embolization effect by multifarious imaging modes, providing a great deal of information for the evaluation of GDC embolization of intracranial aneurysm. DOI: 10.11855/j.issn.0577-7402.2014.02.13

  2. Unstable recent intracapsular femoral neck fractures in young adults: Osteosynthesis and primary valgus osteotomy using broad dynamic compression plate

    Directory of Open Access Journals (Sweden)

    Singh M

    2008-01-01

    Full Text Available Background: Displaced intracapsular femoral neck fractures continue to be a difficult problem to treat. Various treatment modalities and their modifications have been proposed to improve the outcome. Osteosynthesis and primary valgus angulation osteotomy is one of them. Technique and outcome in a consecutive series of recent intracapsular femoral neck fractures in young adults, from a single center, is presented. Materials and Methods: Fifty-five patients of recent (< 3 weeks old displaced intracapsular fracture neck femur (Garden III and IV, Pauwels III, with or without comminution in the age group 20-50 years (mean 35.4±10.4 years were subjected to osteosynthesis and primary valgus intertrochanteric osteotomy using contoured broad dynamic compression plate (DCP. The patients were followed up from two to six years (mean 4.6 years. Results: Fifty-one fractures united by six months of the index procedure (92.7% union range. Avascular necrosis (AVN developed in six patients (11%. The other complications were shortening (six, coxa vara (two, infection (two and delayed union at osteotomy site (one. Excellent results were achieved in 48, good/fair in four and poor in three patients. Conclusion: Osteosynthesis with cancellous screw and primary valgus intertrochanteric osteotomy stabilized by a contoured broad DCP is a simple, easy to perform, biological treatment. Failure in a particular case can be treated with any appropriate second procedure. Level of Evidence: IV

  3. Brain Aneurysm: Treatment Options

    Science.gov (United States)

    ... inoperable aneurysms. Decisions regarding management of an unruptured brain aneurysm are based on the careful comparison of the short- and ... so Tired? How Do I Deal With Depression? Learning Principles to Aid Recovery The Memory Book ... Aneurysm Foundation Support Community Research & Grants BAF Research ...

  4. The pretzel sign: angiographic pattern of tortuous intra-aneurysmal blood flow in a giant serpentine aneurysm.

    LENUS (Irish Health Repository)

    Fanning, N F

    2012-02-03

    Giant serpentine aneurysms (GSAs) form a specific subgroup of giant cerebral aneurysms that have pathognomonic angiographic features. We report the angiographic findings of a GSA demonstrating a striking convoluted dynamic flow pattern, which we have called the \\'pretzel sign\\'. The aneurysm was successfully treated by permanent occlusion of the parent vessel using a detachable balloon. GSAs should be identified prior to treatment in view of their particular management requirements.

  5. Hemodynamics before and after bleb formation in cerebral aneurysms

    Science.gov (United States)

    Cebral, Juan R.; Radaelli, Alessandro; Frangi, Alejandro; Putman, Christopher M.

    2007-03-01

    We investigate whether blebs in cerebral aneurysms form in regions of low or high wall shear stress (WSS), and how the intraaneurysmal hemodynamic pattern changes after bleb formation. Seven intracranial aneurysms harboring well defined blebs were selected from our database and subject-specific computational models were constructed from 3D rotational angiography. For each patient, a second anatomical model representing the aneurysm before bleb formation was constructed by smoothing out the bleb. Computational fluid dynamics simulations were performed under pulsatile flow conditions for both models of each aneurysm. In six of the seven aneurysms, the blebs formed in a region of elevated WSS associated to the inflow jet impaction zone. In one, the bleb formed in a region of low WSS associated to the outflow zone. In this case, the inflow jet maintained a fairly concentrated structure all the way to the outflow zone, while in the other six aneurysms it dispersed after impacting the aneurysm wall. In all aneurysms, once the blebs formed, new flow recirculation regions were formed inside the blebs and the blebs progressed to a state of low WSS. Assuming that blebs form due to a focally damaged arterial wall, these results seem to indicate that the localized injury of the vessel wall may be caused by elevated WSS associated with the inflow jet. However, the final shape of the aneurysm is probably also influenced by the peri-aneurysmal environment that can provide extra structural support via contact with structures such as bone or dura matter.

  6. Isometric and Dynamic Control of Neck Muscles : Reflexive contributions and muscle synergies

    NARCIS (Netherlands)

    De Bruijn, E.

    2014-01-01

    It is well established that the central nervous system (CNS) stabilizes the head using reflexive feedback and cocontraction. The major reflexive pathways in the neck are through muscle spindles generating the cervicocollic reflex (CCR) and through the vestibular organ generating the vestibulocollic

  7. Middle and long-term follow-up of intracranial aneurysms treated with Matrix detachable coils

    International Nuclear Information System (INIS)

    Wu Xi; Liu Jianmin; Huang Qinghai; Xu Yi

    2008-01-01

    Objective: This study was undertaken to evaluate the safety of the polyglycolic/polylactic acid (PGLA)-coated Matrix detachable coils (Matrix) and analyze factors which may relate to the recanalization rate of the Matrix coils in the treatment of intracranial aneurysms. Methods: 75 patients underwent 79 aneurysm treatments with Matrix coils from May 2003 to July 2005 were retrospectively investigated. Morphological changes were compared postoperatively with last-follow-up digital subtraction angiography (DSA) by using the Raymond scale. We defined incomplete recanalization or stable aneurysms as uncured, while those of progressive occlusion or complete occlusion aneurysms demonstrated on the last-follow-up imagings as cured. We also utilized Cox model for analyzing the relationships between factors including age, gender, degree of aneurysmal occlusion, stenting, aneurysm neck size, aneurysm maximum size and Matrix coils length (%) and the long-term angiographic follow-up results. Results: The correlative surgical complications rate with Matrix coils was 13.3%. The total rate of recanalization was 11.4%. Large aneurysms treated with combined stenting got 40% recanalization. No statistic relationships were shown between the factors forementioned and the recanalization rate, but progressive occlusion was observed in 11 (61%)incompletely treated aneurysms. Conclusions: Matrix detachable coil technique is safe for intracranial aneurysm and would further decrease the recurrence of large aneurysm with combination of stenting but long term efficacy needs further follow-up and large scale randomized control study. (authors)

  8. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  9. The use of novel flow diverting device Tubridge for the treatment of intracranial aneurysms: initial experience

    International Nuclear Information System (INIS)

    Yang Pengfei; Liu Jianmin; Huang Qinghai; Xu Yi; Hong Bo; Zhao Wenyuan; Li Qiang; Fang Yibin; Zhang Yuhui

    2011-01-01

    Objective: To preliminarily evaluate the feasibility, efficacy and safety of the novel flow diverting device, Tubridge, in treating intracranial aneurysms. Methods: The novel flow diverting device, Tubridge, was employed to treat intracranial aneurysms in 14 patients with a mean age of (52.4±10.2) years. A total of 14 intracranial aneurysms were detected in 14 patients, including 13 un-ruptured aneurysms and one ruptured aneurysms. The technical results and clinical data were analyzed. Results: A total of 18 flow diverters were implanted. The flow diverter was successfully conveyed and delivered in all patients, with a technical success rate of 100%. Six aneurysms were treated with the flow diverter together with the coils. Of the six aneurysms, complete obliteration of the aneurysm was obtained in 2 (Raymond grade Ⅰ), remnant of neck was seen in 1 (Raymond grade Ⅱ) and residual aneurysm sac was found in 3 (Raymond grade Ⅲ) cases. Eight aneurysms were treated with flow diverter implantation alone. After the procedure, marked decrease in contrast filling of the aneurysm sac was seen in 3 aneurysms, while the change in contrast filling pattern of the aneurysm sac as well as the obvious retention of contrast in the aneurysm sac could be detected in all cases. No procedure-related hemorrhagic or ischemic complications occurred. The mRS score at the time of discharge was 0 (n=13) or 1 (n=1). Conclusion: For the treatment of some special type intracranial aneurysms, the use of Tubridge flow diverter is clinically feasible, its effect is immediate and satisfactory with higher safety in short term. However, its long-term efficacy and safety need to be further evaluated. (authors)

  10. A coil placement technique to treat intracranial aneurysm with incorporated artery.

    Science.gov (United States)

    Luo, Chao-Bao; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

    2018-03-01

    Endovascular coil embolization is an accepted treatment option for intracranial aneurysms. However, the coiling of aneurysms with an incorporated artery (IA) poses a high risk of IA occlusion. Here we report our experience of endovascular coil placement using a technique that avoids IA occlusion in aneurysms with IAs. Over a 6-year period, 185 patients harboring 206 intracranial aneurysms underwent endosaccular coiling. Forty-two of these patients with 45 aneurysms were treated by coil placement to avoid IAs occlusion. We assessed the anatomy of the aneurysms and IAs, technical feasibility of the procedure, and degree of aneurysm occlusion. Clinical and angiographic outcomes were assessed as well. Aneurysms were located in the supra-clinoid intracranial internal carotid artery (n = 24), anterior cerebral artery (n = 6), middle cerebral artery (n = 7), and vertebrobasilar artery (n = 8). The IA was at the aneurysm neck in 34 patients, body in 10, and dome in 1. Immediate post-coiling angiogram showed preservation of blood flow through the IA in all aneurysms. Coil compaction with aneurysmal regrowth was found in 7 of 36 patients having follow-up conventional angiography. One patient had an IA territory infarction after embolization. All 42 patients were followed up (mean: 21 months) and showed no re-bleeding. This technique is effective and safe in managing intracranial aneurysms with IAs. Although aneurysmal recurrence may occur in some aneurysms because of insufficient coiling, this technique is simpler to perform and requires less skill than other techniques. It can be an alternative option for treating some selected intracranial aneurysms with IAs. Copyright © 2017. Published by Elsevier Taiwan LLC.

  11. Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

    International Nuclear Information System (INIS)

    Geyik, Serdar; Yavuz, Kivilcim; Ergun, Onur; Koc, Osman; Cekirge, Saruhan; Saatci, Isil

    2008-01-01

    The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up. Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with ( 25 mm). The embolization technique was the same with that in standard bare coiling. Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively. Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial. (orig.)

  12. Diagnosing thoracic venous aneurysm: A contemporary imaging perspective

    Directory of Open Access Journals (Sweden)

    Rohit Aggarwal

    2017-01-01

    Full Text Available Thoracic venous aneurysms are a rare clinical entity and contrast-enhanced computed tomography has been the cornerstone of their diagnosis. We are reporting a rare case of isolated left brachiocephalic vein aneurysm, which was surgically managed, highlighting the role of dynamic contrast-enhanced magnetic resonance imaging as a definitive diagnostic modality in this patient.

  13. Cerebral foreign body reaction after carotid aneurysm stenting

    DEFF Research Database (Denmark)

    Lorentzen, Anastasia Orlova; Nome, Terje; Bakke, Søren Jacob

    2016-01-01

    Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day...

  14. Intensive dynamic training for females with chronic neck/shoulder pain. A randomized controlled trial

    DEFF Research Database (Denmark)

    Randløv, A; Østergaard, Mikkel; Manniche, C

    1998-01-01

    and activities of daily living (ADL) were used, and strength and endurance measurements of the cervical and shoulder muscles were carried out at baseline and completion of the study. Follow-up measurements were carried out by postal questionnaire at 6 and 12 months after inclusion, and included pain, ADL......OBJECTIVES: To compare the clinical effectiveness of an intensive three-month training programme with a less intensive programme on females suffering from chronic neck/shoulder pain. STUDY DESIGN: A prospective observer-blinded clinical trial including 12-month pretreatment follow-up. SETTING......: Patients were referred to the Departments of Rheumatology and Physical Medicine at Hvidovre Hospital by their general practitioners. Training was undertaken at a satellite clinic for physiotherapy of Hvidovre Hospital. SUBJECTS: Female patients aged 18-65 years suffering from chronic neck/shoulder pain...

  15. Preoperative Evaluation and Endovascular Procedure of Intraoperative Aneurysm Rupture During Thoracic Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Zha, Bin-Shan, E-mail: binszha2013@163.com; Zhu, Hua-Gang, E-mail: huagzhu@yeah.net; Ye, Yu-Sheng, E-mail: yeyusheng@aliyun.com; Li, Yong-Sheng, E-mail: 872868848@qq.com; Zhang, Zhi-Gong, E-mail: zzgedward@sina.com; Xie, Wen-Tao, E-mail: 345344347@qq.com [The First Affiliated Hospital of Anhui Medical University, Department of Vascular Surgery (China)

    2017-03-15

    Thoracic aortic aneurysms are now routinely repaired with endovascular repair if anatomically feasible because of advantages in safety and recovery. However, intraoperative aneurysm rupture is a severe complication which may have an adverse effect on the outcome of treatment. Comprehensive preoperative assessment and considerate treatment are keys to success of endovascular aneurysm repair, especially during unexpected circumstances. Few cases have reported on intraoperative aortic rupture, which were successfully managed by endovascular treatment. Here, we present a rare case of an intraoperative aneurysm rupture during endovascular repair of thoracic aortic aneurysm with narrow neck and angulated aorta arch (coarctation-associated aneurysm), which was successfully treated using double access route approach and iliac limbs of infrarenal devices.Level of EvidenceLevel 5.

  16. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Statistics and Facts A- A A+ Brain Aneurysm Statistics and Facts An estimated 6 million people in ... Understanding the Brain Warning Signs/ Symptoms Brain Aneurysm Statistics and Facts Seeking Medical Attention Risk Factors Aneurysm ...

  17. Outcomes after open repair for ruptured abdominal aortic aneurysms in patients with friendly versus hostile aortoiliac anatomy

    NARCIS (Netherlands)

    van Beek, S. C.; Reimerink, J. J.; Vahl, A. C.; Wisselink, W.; Reekers, J. A.; Legemate, D. A.; Balm, R.

    2014-01-01

    In patients with a ruptured abdominal aortic aneurysm (RAAA), anatomic suitability for endovascular aneurysm repair (EVAR) depends on aortic neck and iliac artery characteristics. If the aortoiliac anatomy is unsuitable for EVAR ("hostile anatomy"), open repair (OR) is the next option. We

  18. Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery.

    Science.gov (United States)

    Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut

    2012-11-01

    Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

  19. An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement.

    Science.gov (United States)

    Png, Chien Yi M; Tadros, Rami O; Beckerman, William E; Han, Daniel K; Tardiff, Melissa L; Torres, Marielle R; Marin, Michael L; Faries, Peter L

    2017-09-01

    Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs. 895 consecutive patients who underwent EVAR for AAA were reviewed, of which 556 met inclusion criteria. A Probit model was created for aneurysm sac enlargement, with preoperative aneurysm morphology, patient demographics, and operative details as variables. Our final model included 287 patients and had a sensitivity of 100%, a specificity of 68.9%, and an accuracy of 70.4%. Ninety-nine (35%) of patients were assigned to the high-risk group, whereas 188 (65%) of patients were assigned to the low-risk group. Notably, regarding anatomic variables, our model reported that age, pulmonary comorbidities, aortic neck diameter, iliac artery length, and aneurysms were independent predictors of post-EVAR sac enlargement. With the exception of age, all statistically significant variables were qualitatively supported by prior literature. With regards to secondary outcomes, the high-risk group had significantly higher proportions of AAA-related deaths (5.1% versus 1.1%, P = 0.037) and Type 1 endoleaks (9.1% versus 3.2%, P = 0.033). Our model is a decent predictor of patients at low risk for post AAA EVAR aneurysm sac enlargement and associated complications. With additional validation and refinement, it could be applied to practices to cut down on the overall need for postimplantation CTA. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Hepatic artery aneurysms (HAAs)

    International Nuclear Information System (INIS)

    Nosratini, H.

    2004-01-01

    The hepatic artery aneurysms are rare, especially in interahepatic branches, The frequency consists of 75-80% extrahepatic and 20-25% intrahepatic. Catheterization is achieved usually from common femoral artery, other methods implemented in the case of unsuccessful catheterization from femoral artery, are translumbar and brachial catheterization. The study consist of 565 patients that were referred to the angiography ward, During seven years of assessment, five cases of hepatic artery aneurysm were found; this is a rare condition reported in the English literature. In the literature as well as in this case report the hepatic artery aneurysms are rare. In reported series the extrahepatic artery aneurysms are found more often than in the intrahepatic artery aneurysm but in this case report intrahepatic artery aneurysms are more than extrahepatic one. (author)

  1. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms.

    Directory of Open Access Journals (Sweden)

    Nan Lv

    Full Text Available The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA aneurysms.In 129 PCoA aneurysms (85 ruptured, 44 unruptured, clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms.While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR, size ratio (SR, dome-to-neck ratio (DN, inflow angle (IA, normalized wall shear stress (NWSS and percentage of low wall shear stress area (LSA were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001 and LSA (OR = 1.393, p = 0.041.Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms.

  2. Osteosynthesis of femoral neck fractures: dynamic hip screw (DHS or mini-invasive Targon FN system?

    Directory of Open Access Journals (Sweden)

    A. K. Dulaev

    2015-01-01

    Full Text Available Objectives: to investigate the long-term outcomes of femoral neck fractures that were surgically fixed using various types of extramedullary implants in patients aged 65 years and younger. Material and methods: We analyzed the clinical results of surgical treatment of femoral neck fractures by extramedullary osteosynthesis in 94 patients aged 38 to 65 years old (71 women and 23 men. The patients were divided into 3 groups according to AO/ASIF fracture classification. We used different techniques of osteosynthesis: with DHS or with Targon FN. In all patients the mental status rate SPMSQ, osteoporosis degree (Singh index, general somatic status (WHO scale were evaluated in the preoperative period. We also evaluated next intraoperative parameters: duration of surgery, blood loss, quality of reduction, long of incision. In a year after surgery we assessed functional results (Harris Hip Score and analysed postoperative complications. Results: It was found the inverse correlation (r = -0,8 of total preoperative parameters (WHO scale, the Singh index and mental status SPMSQ and postoperative functional results on Harris Hip Score. With the reliability of p<0.05 the average rate of blood loss and length of skin incision were less in patients operated with Targon FN. In 12 months unsatisfactory results rate on Harris Hip Score was 12.7% in all study groups, great - 22,3%, good - 52.1%, and satisfactory - 12,9%. Complications rate in patients operated with DHS was 17,02%, and in patients operated with Targon FN - 18.1%. Conclusion: Minimally invasive osteosynthesis of femoral neck fractures (type B1 and B2 on AO/ASIF classification allows to achieve the best results in compare with DHS osteosynthesis. Revealed complications such as screw migration, false joint formation and femoral head avascular necrosis were determined by impaired surgical technique and inadequate reduction.

  3. Anterior petroclinoid fold fenestration: an adjunct to clipping of postero-laterally projecting posterior communicating aneurysms.

    Science.gov (United States)

    Nossek, Erez; Setton, Avi; Dehdashti, Amir R; Chalif, David J

    2014-10-01

    Proximally located posterior communicating artery (PCoA) aneurysms, projecting postero-laterally in proximity to the tentorium, may pose a technical challenge for microsurgical clipping due to obscuration of the proximal aneurysmal neck by the anterior petroclinoid fold. We describe an efficacious technique utilizing fenestration of the anterior petroclinoid fold to facilitate visualization and clipping of PCoA aneurysms abutting this aspect of the tentorium. Of 86 cases of PCoA aneurysms treated between 2003 and 2013, the technique was used in nine (10.5 %) patients to allow for adequate clipping. A 3 mm fenestration in the anterior petroclinoid ligament is created adjacent and lateral to the anterior clinoid process. This fenestration is then widened into a small wedge corridor by bipolar coagulation. In all cases, the proximal aneurysm neck was visualized after the wedge fenestration. Additionally, an adequate corridor for placement of the proximal clip blade was uniformly established. All cases were adequately clipped, with complete occlusion of the aneurysm neck and fundus with preservation of the PCoA. There were two intraoperative ruptures not related to creation of the wedge fenestration. One patient experienced post-operative partial third nerve palsy, which resolved during follow-up. We describe a technique of fenestration of the anterior petroclinoid fold to establish a critical and safe corridor for both visualization and clipping of PCoA aneurysms.

  4. Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device.

    Science.gov (United States)

    Marotta, Thomas R; Riina, Howard A; McDougall, Ian; Ricci, Donald R; Killer-Oberpfalzer, Monika

    2018-02-01

    OBJECTIVE Intracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations. METHODS A preclinical model of wide-necked bifurcation aneurysms in rabbits was used to assess functional features and efficacy of aneurysm occlusion by the eCLIPs device. RESULTS The eCLIPs device, in bridging the aneurysm neck, allows coil retention, disrupts flow away from the aneurysm, leaves the main vessel and side branches unencumbered by intraluminal metal, and serves as a platform for endothelial growth across the neck, excluding the aneurysm from the circulation. CONCLUSIONS The eCLIPs device permits physiological remodeling of the bifurcation.

  5. Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

    Energy Technology Data Exchange (ETDEWEB)

    Geyik, Serdar; Yavuz, Kivilcim; Ergun, Onur; Koc, Osman; Cekirge, Saruhan [Hacettepe University Hospitals, Department of Radiology, Ankara (Turkey); Saatci, Isil [Hacettepe University Hospitals, Department of Radiology, Ankara (Turkey); Hacettepe University Hospital, Interventional Neuroradiology Unit, Department of Radiology, Ankara (Turkey)

    2008-09-15

    The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up. Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck ({>=}4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling. Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively. Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial. (orig.)

  6. Closed-cell stent for coil embolization of intracranial aneurysms: clinical and angiographic results.

    Science.gov (United States)

    Wakhloo, A K; Linfante, I; Silva, C F; Samaniego, E A; Dabus, G; Etezadi, V; Spilberg, G; Gounis, M J

    2012-10-01

    Recanalization is observed in 20-40% of endovascularly treated intracranial aneurysms. To further reduce the recanalization and expand endovascular treatment, we evaluated the safety and efficacy of closed-cell SACE. Between 2007 and 2010, 147 consecutive patients (110 women; mean age, 54 years) presenting at 2 centers with 161 wide-neck ruptured and unruptured aneurysms were treated by using SACE. Inclusion criteria were wide-neck aneurysms (>4 mm or a dome/neck ratio ≤ 2). Clinical outcomes were assessed by the mRS score at baseline, discharge, and follow-up. Aneurysm occlusion was assessed on angiograms by using the RS immediately after SACE and at follow-up. Eighteen aneurysms (11%) were treated following rupture. Procedure-related mortality and permanent neurologic deficits occurred in 2 (1.4%) and 5 patients (3.4%), respectively. In total, 7 patients (4.8%) died, including 2 with reruptures. Of the 140 surviving patients, 113 (80.7%) patients with 120 aneurysms were available for follow-up neurologic examination at a mean of 11.8 months. An increase in mRS score from admission to follow-up by 1, 2, or 3 points was seen in 7 (6.9%), 1 (1%), and 2 (2%) patients, respectively. Follow-up angiography was performed in 120 aneurysms at a mean of 11.9 months. Recanalization occurred in 12 aneurysms (10%), requiring retreatment in 7 (5.8%). Moderate in-stent stenosis was seen in 1 (0.8%), which remained asymptomatic. This series adds to the evidence demonstrating the safety and effectiveness of SACE in the treatment of intracranial aneurysms. However, SACE of ruptured aneurysms and premature termination of antiplatelet treatment are associated with increased morbidity and mortality.

  7. Dynamics of biochemical and immunological blood markers in patients with pseudoarthrosis of the femoral neck after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    S. E. Bondarenko

    2017-08-01

    Full Text Available The importance of biomarkers to predict recovery following total hip arthroplasty (THA is still unclear to clinicians. To assess the preoperative biomarkers of patients with pseudoarthrosis of the femoral neck and their dynamics in the early postoperative period after THA, 50 patients aged 33 to 82 years old, 18 males and 32 females diagnosed with pseudoarthrosis of the femoral neck after failed internal fixation and failed conservative management were studied. The control group consisted of 30 healthy people aged 27 to 50 years, 13 males, 17 females. Patients’ blood was examined for biochemical markers upon admission, and then on the 7th and 14th days after surgery. Their blood serum content of total protein, albumin, glycoproteins, sialic acids, chondroitin sulfates, haptoglobin, glucose, cholesterol, triglycerides, ALT, AST, alkaline phosphatase, GGT, acid phosphatase, thymol index; interleukins (IL-1, IL-4 and IL-6. and C-reactive protein was measured. The content of glycoproteins in the blood exceeded the norm by 2.3 times, chondroitin sulfate by 4.7 times, sialic acids by 1.5 times, haptoglobin by 55.8%, fibrinogen by 19.1%, globulin by 19,6%, alkaline phosphatase activity by 72.3%, IL-1 by 94.7 and IL-6 by 3 times, C-reactive protein by 2.6 times. After THA there was a gradual decrease in blood biochemical and immunological markers. The most informative laboratory markers were glycoproteins, chondroitin sulfates, sialic acids, haptoglobin, activity of alkaline phosphatase, IL-1, IL-6 and IL-4, and C-reactive protein. Subsequent research is required to validate these dynamics.

  8. GDC 360 for the endovascular treatment of intracranial aneurysms: a matched-pair study analysing angiographic outcomes with GDC 3D coils in 38 patients

    International Nuclear Information System (INIS)

    Taschner, Christian A.; Thines, Laurent; Lejeune, Jean-Paul; El-Mahdy, Mohamed; Rachdi, Henda; Gauvrit, Jean-Yves; Pruvo, Jean-Pierre; Leclerc, Xavier

    2009-01-01

    The purpose of this study was to determine whether coil embolisation with a new complex-shaped Guglielmi Detachable Coil (GDC 360 ; Boston Scientific Neurovascular, Fremont, CA, USA) has any effect on the stability of aneurysm occlusion. Fifty-one consecutive patients with intracranial aneurysms treated with GDC 360 were included. Angiographic results and adverse neurological events during the follow-up period were recorded. For 38 patients treated with GDC 360 with available follow-up data, a corresponding patient treated with GDC 3D was identified from our database. Matches were sought for rupture status, location, aneurysmal size, and neck size. The angiographic outcome of these matched controls at 6 months was compared to aneurysms treated with GDC 360 . Initial angiographic controls for 38 patients treated with GDC 360 showed complete occlusion in 32 aneurysms, and a neck remnant in six. At 6-month follow-up, complete occlusion was found in 29, a neck remnant in eight, and a residual aneurysm in one. One patient treated with GDC 360 needed retreatment for a major recanalisation. In 38 matched patients treated with GDC 3D, initial angiographic controls found complete aneurysmal occlusion in 30 aneurysms and a residual neck in 8. At 6-month follow-up, 24 aneurysms were completely occluded, ten showed a neck remnant, and residual aneurysms were seen in four. Four patients, treated with GDC 3D, were retreated for major aneurysm recanalisations. Our data suggests that endovascular coil embolisation with GDC 360 might improve long-term stability of coiled aneurysms when compared to GDC 3D. (orig.)

  9. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    Directory of Open Access Journals (Sweden)

    Jacek Brzost

    2015-01-01

    Full Text Available The extracranial internal carotid artery aneurysm (EICAA is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63×55×88 mm, stretching from the skull base to the angle of the mandible.

  10. Dynamical effects in heavy ion collisions: neck emission in the Pb + Au system at 29 A.MeV

    International Nuclear Information System (INIS)

    Aboufirassi, M; Bizard, G.; Bougault, R.; Brou, R.; Buta, A.; Colin, J.; Cussol, D.; Durand, D.; Genoux-Lubain, A.; Horn, D.; Kerambrun, A.; Laville, J.L.; Le Brun, C.; Lecolley, J.F.; Lefebvres, F.; Lopez, O.; Louvel, M.; Meslin, C.; Metivier, V.; Nakagawa, T.; Peter, J.; Popescu, R.; Regimbart, R.; Steckmeyer, J.C.; Tamain, B.; Vient, E.; Wieloch, A.; Yuasa-Nakagawa, K.

    1998-01-01

    In the study of the Pb + Au system with the assembly NAUTILUS a special class of events were made evident. Three body complete events have allowed observing a dynamical behavior in the fragment emission. A plot of the correlation between the emission angle and the charges Z 1 and Z 2 of the two fragments associated to the event shows a contribution of an intermediate mass third fragment reflecting a dynamical emission subsequent to the interaction phase between the two partners of the deep inelastic scattering (a phenomenon featuring the neck emission). Such a process has been observed in the Kr + Au at 60 MeV/nucleon and Xe + Cu at 50 MeV/nucleon. The on-going analysis of the Xe + Sn at 50 MeV/nucleon reveals the existence of a similar mechanism. A complete kinematical analysis of this class of events has permitted making evident the impact parameter window, here implied; it is situated for the associated collisions to an reduced impact parameter around 0.8 b max , corresponding to an excitation energy for the bi-nucleus system of the order of 2 MeV/nucleon. This phenomenon may allow to constrain more strongly the models describing the dynamics of the heavy ion collisions, particularly the kinetic models of Landau-Vlasov type. Then, the different mean field potential prescriptions my be tested by comparison with the experimental data

  11. Cartilage and bone neoformation in rabbit carotid bifurcation aneurysms after endovascular coil embolization

    Directory of Open Access Journals (Sweden)

    H Plenk

    2008-11-01

    Full Text Available Occurrence and histomorphology of cartilage and bone neoformations was retrospectively evaluated in rabbit experimental aneurysms after endovascular coil embolization. During product development, 115 carotid bifurcation aneurysms were treated with hydrogel-containing devices (HydroCoil®, n=77; HydroSoft®, n=28; prototype Hydrogel-only, n=10; MicroVentionTerumo, Aliso Viejo, CA. Additional 29 aneurysms were treated with standard (n=22 or with degradable polymer-covered (n=7 platinum coils. After 4 to 52 weeks, the retrieved aneurysms were methylmethacrylate embedded, and ground sections were surface-stained with Rapid Bone Stain and Giemsa solution. Cartilage and/or bone tissue was assessed by light microscopy; respective tissue areas in the aneurysms were determined by computerized histomorphometry. Cartilage neoformation was observed from 26 to 52 weeks. Single chondrocytes to hyaline or fibrous cartilage areas, occupying up to 29% of the aneurysm cavity, were found in 6 aneurysms, treated with HydroCoil (n=4, Hydrogel-only (n=1, and resorbable polymer (n=1 devices. Chondral ossification associated cartilage neoformation in 2 of these 4 HydroCoil-treated aneurysms. Membranous woven and lamellar bone ossicles were observed from 13 to 52 weeks in 7 aneurysms, treated with HydroCoil (n=3 and platinum coil (n=4 devices. Altogether, cartilage and/or bone neoformation was observed in 13 (9% of 144 rabbit bifurcation aneurysms treated with various embolic devices. Incidence was low until 26 weeks, but increased at 52 weeks in both, HydroCoil and standard platinum coil treated aneurysms. As the neoformations were predominantly located in proximity to the aneurysm neck, they could be related to the long-term mechanobiology of cell differentiation during fibrovascular healing of blood flow-exposed embolized aneurysms.

  12. Experimental studies on canine terminal carotid arterial aneurysm models pre- and post-embolized with microcoil

    International Nuclear Information System (INIS)

    Wang Qihong; Zhou Liangfu; Gong Jianqiu; Dai Jianhua; Zhang Xiaojun; Zhang Xinyuan

    2005-01-01

    Objective: To establish canine terminal saccular aneurysm model of common carotid artery (CCA), and evaluate the images and hemodynamic changes of aneurysm cavities pre- and post-embolized with microcoil (MC). Methods: Seven CCA terminal saccular aneurysm models had been created by using improved microsurgical technique. Seven to fourteen days after surgery, models were undergone color Doppler, Magnetic resonance image (MRI), Magnetic resonance angiography (MRA), digital subtraction angiography (DSA), and then the analysis of computational fluid dynamics (CFD) on these animal models were conducted. Afterwards they were compactly packed with MC, and then aneurysms again were examed under these methods, and simulation of pathological changes. Results: Models were created successfully with good MC compactly pack aneurysm cavities. DSA combined with other imaging methods can improve the diagnosis of aneurysms completely. CFD models can show the imitation hemodynamics of canine carotid aneurysms. Conclusions: This kind of aneurysm model is an ideal one on the area for the research of aneurysm embolization. Non-DSA imaging examination can noninvasively, repeatedly, clearly evaluate aneurysms pre- and post-embolized with MC. The interference on the inflow zone of the aneurysm is an effective method for cure and preventing recurrence of aneurysms. (authors)

  13. Aneurysms in the vertebro-basilary flow region: standard protections (town and lateral projections), BASIS projections, and ispilateral inclined exposures

    International Nuclear Information System (INIS)

    Hering, M.; Zwicker, C.; Wakhloo, A.K.; Schumacher, M.

    1998-01-01

    In spite of procedures such as CT angiography, MR angiography, and rotation angiography, panangiography is still indispensable in therapeutic planning for cerebral aneurysms. It is the only method that provides exact details about the size, anatomic localization, and multiplicity of aneurysms as well as relation to surrounding vessels, the presence of an aneurysmal neck, and for the evaluation of the collateral circulation required to answer the question if endovascular therapy is possible. In addition, panangiography still exhibits the highest selectivity in the detection of cerebral aneurysms. (orig.) [de

  14. A dynamic supraclavicular field-matching technique for head-and-neck cancer patients treated with IMRT

    International Nuclear Information System (INIS)

    Duan, Jun; Shen Sui; Spencer, Sharon A.; Ahmed, Raef S.; Popple, Richard A.; Ye, Sung-Joon; Brezovich, Ivan A.

    2004-01-01

    Purpose: The conventional single-isocenter and half-beam (SIHB) technique for matching supraclavicular fields with head-and-neck (HN) intensity-modulated radiotherapy (IMRT) fields is subject to substantial dose inhomogeneities from imperfect accelerator jaw/MLC calibration. It also limits the isocenter location and restricts the useful field size for IMRT. We propose a dynamic field-matching technique to overcome these limitations. Methods and materials: The proposed dynamic field-matching technique makes use of wedge junctions for the abutment of supraclavicular and HN IMRT fields. The supraclavicular field was shaped with a multileaf collimator (MLC), which was orientated such that the leaves traveled along the superoinferior direction. The leaves that defined the superior field border moved continuously during treatment from 1.5 cm below to 1.5 cm above the conventional match line to generate a 3-cm-wide wedge-shaped junction. The HN IMRT fields were optimized by taking into account the dose contribution from the supraclavicular field to the junction area, which generates a complementary wedge to produce a smooth junction in the abutment region. This technique was evaluated on a polystyrene phantom and 10 HN cancer patients. Treatment plans were generated for the phantom and the 10 patients. Dose profiles across the abutment region were measured in the phantom on films. For patient plans, dose profiles that passed through the center of the neck lymph nodes were calculated using the proposed technique and the SIHB technique, and dose uniformity in the abutment region was compared. Field mismatches of ± 1 mm and ± 2 mm because of imperfect jaw/MLC calibration were simulated, and the resulting dose inhomogeneities were studied for the two techniques with film measurements and patient plans. Three-dimensional volumetric doses were analyzed, and equivalent uniform doses (EUD) were computed. The effect of field mismatches on EUD was compared for the two match

  15. Surgical approach to giant aneurysms of the anterior circulation.

    Science.gov (United States)

    Giombini, S; Solero, C L; Ferraresi, S; Melcarne, A; Broggi, G; Pluchino, F

    1988-01-01

    The surgical approach to cerebral giant aneurysms is still a source of great concern. We describe our experience with giant aneurysms of the anterior circulation and discuss the different surgical techniques adopted. During the period January 1972-December 1985, a total of 33 patients were operated upon at the Istituto Neurologico "C. Besta" of Milan for a giant aneurysm of the anterior circulation. Nineteen cases had suffered subarachnoid haemorrhage before admission; in 14 cases the hospitalization was due to evidence of mass effect on the surrounding neurovascular structures. All aneurysms were directly approached: in 24 cases the neck was occluded by a suitable clip, in 4 cases intramural thrombosis was attempted, in 3 cases the aneurysms were definitively trapped and in one case aneurysmorrhaphy was performed after resection of the sac. Operative mortality was 12%. Long-term follow-up shows good results whenever exclusion of the aneurysm from cerebral circulation had been achieved, either after removal of the sac or not; on the contrary, only fair or poor results were evident when other surgical techniques were adopted, either electively or out of necessity. The importance of intraoperative protection and monitoring of brain function is stressed.

  16. Treatment of anterior communicating artery aneurysms with Guglielmi detachable coils

    International Nuclear Information System (INIS)

    Xu Yi; Liu Jianmin; Hong Bo; Zhao Wenyuan; Huang Qinghai; Zhang Xin; Zhang Long

    2003-01-01

    Objective: To summarize the experience on endovascular treatment of anterior communicating artery aneurysms with Guglielmi detachable coils (GDCs) in 262 cases. Methods: All aneurysms were embolized with GDCs. Catheterization at both ICA was used to monitor the patency of parent arteries for patients with well-developed A1 segment of both ACAs. Microcatheter-assisted or microwire-assisted technique was undertaken to keep patency of parent arteries if the aneurysmal neck was involved with A2 segment. Thirty-four cases with multiple aneurysms had been treated successfully only in one session. Results: Complete embolization was achieved in 160 cases, while subtotal in 56 (>90%) and partial in 46 (<90%). Occlusion of parent arteries developed in 10 cases because of over-occlusion, and cerebral infarction was found in 16 cases after the procedure. Three cases with procedure-related thrombosis were revascularized by urokinase profusion. Follow-up angiograms of 3-6 months showed recanalization in 8 cases requiring a second time session. One case of recurrent aneurysm after GDC treatment was cured by surgical clipping. Conclusions: The result of endovascular treatment of anterior communicating artery aneurysms is fruitful and seems to be an alternative method in improving the rate of occlusion and reducing the cerebral infarction

  17. Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders

    Science.gov (United States)

    Peolsson, Anneli; Peterson, Gunnel; Trygg, Johan; Nilsson, David

    2016-08-01

    Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD.

  18. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms.

    Science.gov (United States)

    Lv, Nan; Wang, Chi; Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2016-01-01

    The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms. While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR), size ratio (SR), dome-to-neck ratio (DN), inflow angle (IA), normalized wall shear stress (NWSS) and percentage of low wall shear stress area (LSA) were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p PCoA aneurysms.

  19. The Use of Flow Diverting Stents to Treat Para-Ophthalmic Aneurysms

    Directory of Open Access Journals (Sweden)

    Pervinder Bhogal

    2017-08-01

    Full Text Available Background and purposeFew publications have dealt exclusively with the use of flow diverter stents for the treatment of para-ophthalmic aneurysms. We sought to determine the efficacy of flow diverting stents (FDSs to treat aneurysms in this specific location.MethodsWe retrospectively reviewed our database of prospectively collected information for all patients treated with flow diversion for an unruptured saccular para-ophthalmic aneurysm between September 2009 and January 2016. The aneurysm fundus size, neck size, number and type of FDS, complications, and follow-up data were recorded.ResultsWe identified 74 patients that matched our inclusion criteria. Of these patients, 18 patients were male (24.3%. The average fundus size was 4.8 mm, 11 aneurysms had previous coil occlusions and 63 were treated solely with flow diversion. At an initial angiographic follow-up (mean avg. 3.2 months, 71.8% of the aneurysms were occluded, and at the last follow-up (mean avg. 31.8 months, 88.9% of aneurysms were occluded. One patient suffered permanent morbidity (1.36% secondary to interruption of the antiplatelet medication and another died (1.36% secondary to in-stent thrombosis that was also due to an interruption in the antiplatelet medication.ConclusionTreatment of saccular para-ophthalmic aneurysms with FDS is feasible and carries a high degree of technical success with low complication rates and excellent rates of aneurysm exclusion.

  20. Kinetic analysis of dynamic 18F-fluoromisonidazole PET correlates with radiation treatment outcome in head-and-neck cancer

    Directory of Open Access Journals (Sweden)

    Paulsen Frank

    2005-12-01

    Full Text Available Abstract Background Hypoxia compromises local control in patients with head-and-neck cancer (HNC. In order to determine the value of [18F]-fluoromisonidazole (Fmiso with regard to tumor hypoxia, a patient study with dynamic Fmiso PET was performed. For a better understanding of tracer uptake and distribution, a kinetic model was developed to analyze dynamic Fmiso PET data. Methods For 15 HNC patients, dynamic Fmiso PET examinations were performed prior to radiotherapy (RT treatment. The data was analyzed using a two compartment model, which allows the determination of characteristic hypoxia and perfusion values. For different parameters, such as patient age, tumor size and standardized uptake value, the correlation to treatment outcome was tested using the Wilcoxon-Mann-Whitney U-test. Statistical tests were also performed for hypoxia and perfusion parameters determined by the kinetic model and for two different metrics based on these parameters. Results The kinetic Fmiso analysis extracts local hypoxia and perfusion characteristics of a tumor tissue. These parameters are independent quantities. In this study, different types of characteristic hypoxia-perfusion patterns in tumors could be identified. The clinical verification of the results, obtained on the basis of the kinetic analysis, showed a high correlation of hypoxia-perfusion patterns and RT treatment outcome (p = 0.001 for this initial patient group. Conclusion The presented study established, that Fmiso PET scans may benefit from dynamic acquisition and analysis by a kinetic model. The pattern of distribution of perfusion and hypoxia in the tissue is correlated to local control in HNC.

  1. Dynamic MRI of tumours in head and neck with a contrast-enhanced FLASH-2D sequence

    International Nuclear Information System (INIS)

    Maeurer, J.; Rausch, M.; Richter, W.S.; Boeck, J.C.; Steinkamp, H.J.; Vogl, T.J.; Felix, R.

    1995-01-01

    The purpose of this study was to evaluate the utility of a dynamic contrast enhanced FLASH-2D sequence for differential diagnosis of tumours in head and neck in 93 patients. Initially, the localization of the lesion and the selection of four representative slices for the dynamic study were obtained by a T2-weighted spin-echo sequence (TR 2000-3000 ms; TE 25/90 ms). After IV bolus injection of the contrast agent 10 images were acquired during a period of 3 min by a FLASH-2D sequence (TR 60 ms; TE 6 ms; flip angle 40 ; matrix 256 x 256; one acquisition). The percentage signal intensity (SI) increase (r) and the slope (S) of the curve were calculated on the basis of the SI time curve of the pathological lesion and of muscle. Inflammatory processes could be differentiated from malignant or benign tumours by means of a higher contrast enhancement. The time of the maximum SI was not specific for the different lesions. In comparison with muscle the maximum SI change was achieved earlier in a pathological process. (orig.)

  2. Effects of Intraluminal Thrombus on Patient-Specific Abdominal Aortic Aneurysm Hemodynamics via Stereoscopic Particle Image Velocity and Computational Fluid Dynamics Modeling

    Science.gov (United States)

    Chen, Chia-Yuan; Antón, Raúl; Hung, Ming-yang; Menon, Prahlad; Finol, Ender A.; Pekkan, Kerem

    2014-01-01

    The pathology of the human abdominal aortic aneurysm (AAA) and its relationship to the later complication of intraluminal thrombus (ILT) formation remains unclear. The hemodynamics in the diseased abdominal aorta are hypothesized to be a key contributor to the formation and growth of ILT. The objective of this investigation is to establish a reliable 3D flow visualization method with corresponding validation tests with high confidence in order to provide insight into the basic hemodynamic features for a better understanding of hemodynamics in AAA pathology and seek potential treatment for AAA diseases. A stereoscopic particle image velocity (PIV) experiment was conducted using transparent patient-specific experimental AAA models (with and without ILT) at three axial planes. Results show that before ILT formation, a 3D vortex was generated in the AAA phantom. This geometry-related vortex was not observed after the formation of ILT, indicating its possible role in the subsequent appearance of ILT in this patient. It may indicate that a longer residence time of recirculated blood flow in the aortic lumen due to this vortex caused sufficient shear-induced platelet activation to develop ILT and maintain uniform flow conditions. Additionally, two computational fluid dynamics (CFD) modeling codes (Fluent and an in-house cardiovascular CFD code) were compared with the two-dimensional, three-component velocity stereoscopic PIV data. Results showed that correlation coefficients of the out-of-plane velocity data between PIV and both CFD methods are greater than 0.85, demonstrating good quantitative agreement. The stereoscopic PIV study can be utilized as test case templates for ongoing efforts in cardiovascular CFD solver development. Likewise, it is envisaged that the patient-specific data may provide a benchmark for further studying hemodynamics of actual AAA, ILT, and their convolution effects under physiological conditions for clinical applications. PMID:24316984

  3. DSA volumetric 3D reconstructions of intracranial aneurysms: A pictorial essay

    Science.gov (United States)

    Cieściński, Jakub; Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

    2012-01-01

    Summary A gold standard of cerebral vessel imaging remains the digital subtraction angiography (DSA) performed in three projections. However, in specific clinical cases, many additional projections are required, or a complete visualization of a lesion may even be impossible with 2D angiography. Three-dimensional (3D) reconstructions of rotational angiography were reported to improve the performance of DSA significantly. In this pictorial essay, specific applications of this technique are presented in the management of intracranial aneurysms, including: preoperative aneurysm evaluation, intraoperative imaging, and follow-up. Volumetric reconstructions of 3D DSA are a valuable tool for cerebral vessels imaging. They play a vital role in the assessment of intracranial aneurysms, especially in evaluation of the aneurysm neck and the aneurysm recanalization. PMID:22844309

  4. Endovascular Aneurysm Repair and Sealing (EVARS): A Useful Adjunct in Treating Challenging Morphology

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, Gareth J., E-mail: garethjamesharrison@yahoo.co.uk; Antoniou, George A., E-mail: antoniou.ga@hotmail.com; Torella, Francesco, E-mail: francesco.torella@rlbuht.nhs.uk; McWilliams, Richard G., E-mail: richard.mcwilliams@rlbuht.nhs.uk; Fisher, Robert K., E-mail: robert.fisher@rlbuht.nhs.uk [Royal Liverpool University Hospital, Liverpool Vascular and Endovascular Service (United Kingdom)

    2016-04-15

    An 81-year-old male with previous open abdominal aortic aneurysm repair presented with asymptomatic large pseudoaneurysms at both ends of an open surgical tube graft. Endovascular aneurysm sealing (EVAS) in combination with the iliac limbs of a standard endovascular aneurysm repair (EVAR) successfully excluded both pseudoaneurysms from circulation. We describe the combination of elements of EVAS and EVAR and have termed this endovascular aneurysm repair and sealing (EVARS). EVARS has the advantage of harnessing the benefits of endobag sealing in aortic necks unsuitable for standard EVAR whilst providing the security of accurate stent placement within short common iliac arteries. In conclusion, EVAS may be combined with standard endovascular iliac limbs and is a possible treatment option for pseudoaneurysm following open aneurysm repair.

  5. Topographic anatomy of paraclinoid carotid artery aneurysms: usefulness of MR angiographic source images

    International Nuclear Information System (INIS)

    Nagasawa, S.; Deguchi, J.; Arai, M.; Tanaka, H.; Kawanishi, M.; Ohta, T.

    1997-01-01

    We evaluated the usefulness of magnetic resonance angiography (MRA) for showing the topography of paraclinoid carotid artery aneurysms in 27 patients with 30 paraclinoid aneurysms undergoing conventional angiography, three-dimensional time-of-flight MRA and surgery. The anatomy shown on the axial MRA source images was consistent with that found at surgery. The neck of the aneurysm could always be identified on the source images, while it could not be analysed exactly on conventional angiography in 3 cases (10 %). The optic nerves, including those displaced by the aneurysm, were recognised in all patients. The anterior clinoid process was shown as a low-intensity rim or area contiguous with the cortical bone. The source images were of great value in understanding the topography of paraclinoid carotid artery aneurysms. (orig.). With 2 figs

  6. Surgical ablation of ventricular tachycardia secondary to congenital ventricular septal aneurysm.

    Science.gov (United States)

    Graffigna, A; Minzioni, G; Ressia, L; Vigano, M

    1994-04-01

    Three patients underwent surgical ablation for ventricular tachycardia resulting from an aneurysm of the membranous portion of the ventricular septum. Two patients had a definite history of cardiac murmur during infancy, and one of them was found at the time of operation to have a left-to-right shunt through the apex of the aneurysm. The earliest ventricular activation sites were located around the neck of the aneurysm and were ablated in 1 patient by encircling the endocardial ventriculotomy and by cryoablation in the remaining 2. After focus resection had been completed, aneurysm resection and ventricular septal reconstruction were performed. All patients were alive and free of ventricular tachycardia and did not need medication as of 61, 66, and 88 months postoperatively. Spontaneous closure of a ventricular septal defect may lead to the formation of an aneurysm in the ventricular septum that may sustain ventricular tachycardias. Such arrhythmias can be effectively treated using electrically guided surgical techniques.

  7. Giant partially thrombosed 4 th ventricular posterior inferior cerebellar artery aneurysm; microsurgical management

    Directory of Open Access Journals (Sweden)

    Forhad Hossain Chowdhury

    2014-01-01

    Full Text Available A 42-year-old woman presented with a 3-month history of progressive occipital headache, vomiting, walking difficulty, and repeated fall. She had no history of sudden and severe headache. She had positive cerebellar signs, predominantly on the right side. Computerized tomography (CT scan, CT angiogram, and magnetic resonance image (MRI of the brain showed suspected partially thrombosed giant 4 th ventricular posterior inferior cerebellar artery aneurysm. Patient developed severe hypersensitivity reaction during both CT scan and MRI after contrast injection. Though needed, digital subtraction angiogram (DSA of cerebral vessels was not done. The aneurysm was managed by microsurgical clipping of the aneurysm neck and partial excision of thrombosed aneurysm. Here, we report the details of management of these difficult giant aneurysm without DSA.

  8. Aneurysm pulsatility after endovascular exclusion: an experimental study using human aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Hussein Amin Orra

    2008-01-01

    Full Text Available OBJECTIVE: To measure the pulsatility of human aneurysms before and after complete exclusion with an endograft. METHOD: Five aortic aneurysms obtained during necropsy were submitted to pulsatile perfusion before and after implantation of a bifurcated endograft. The specimens were contained in a closed chamber filled with saline solution. A vertical tube attached to the chamber was used to measure volume dislocation in each systole. Mural thrombus was kept intact, and the space around the device was filled with human blood. After each experiment, the aneurysm was opened to check for the correct positioning and attachment of the device. RESULTS: The level of the saline column oscillated during pulsation in each case, with respective amplitudes of 17, 16, 13, 7, and 25 cm before the endograft insertion. After the insertion, the amplitudes dropped to 13, 12, 9, 3.5, and 23 cm, respectively. The differences were not significant. During the post-experimental examination, all devices were found to be in position and well attached to the neck and iliacs. No endoleak was detected during perfusion or by visual inspection. CONCLUSION: Pulsation of an endograft is transmitted to the aneurysm wall even in the absence of endoleak, and should not be interpreted as procedural failure.

  9. Contrast settling in cerebral aneurysm angiography

    International Nuclear Information System (INIS)

    Wang Zhijie; Hoffmann, Kenneth R; Guterman, Lee R; Wang Zhou; Rudin, Stephen; Meng Hui

    2005-01-01

    During angiography, blood flow is visualized with a radiopaque contrast agent, which is denser than blood. In complex vasculature, such as cerebral saccular aneurysms, the density difference may produce an appreciable gravity effect, where the contrast material separates from blood and settles along the gravity direction. Although contrast settling has been occasionally reported before, the fluid mechanics behind it have not been explored. Furthermore, the severity of contrast settling in cerebral aneurysms varies significantly from case to case. Therefore, a better understanding of the physical principles behind this phenomenon is needed to evaluate contrast settling in clinical angiography. In this study, flow in two identical groups of sidewall aneurysm models with varying parent-vessel curvature was examined by angiography. Intravascular stents were deployed into one group of the models. To detect contrast settling, we used lateral view angiography. Time-intensity curves were analysed from the angiographic data, and a computational fluid dynamic analysis was conducted. Results showed that contrast settling was strongly related to the local flow dynamics. We used the Froude number, a ratio of flow inertia to gravity force, to characterize the significance of gravity force. An aneurysm with a larger vessel curvature experienced higher flow, which resulted in a larger Froude number and, thus, less gravitational settling. Addition of a stent reduced the aneurysmal flow, thereby increasing the contrast settling. We found that contrast settling resulted in an elevated washout tail in the time-intensity curve. However, this signature is not unique to contrast settling. To determine whether contrast settling is present, a lateral view should be obtained in addition to the anteroposterior (AP) view routinely used clinically so as to rule out contrast settling and hence to enable a valid time-intensity curve analysis of blood flow in the aneurysm

  10. Stent-Assisted Coil Embolization of a Mycotic Renal Artery Aneurysm by Use of a Self-Expanding Neurointerventional Stent

    International Nuclear Information System (INIS)

    Rabellino, Martin; García-Nielsen, Luis; Zander, Tobias; Baldi, Sebastián; Llorens, Rafael; Maynar, Manuel

    2011-01-01

    Mycotic aneurysms are uncommon, especially those located in visceral arteries. We present a case of a patient with two visceral mycotic aneurysms due to bacterial endocarditis, one located in right upper pole renal artery and the second in the splenic artery. Both aneurysms were treated as endovascular embolization using microcoils. In the aneurysm located at the renal artery, the technique of stent-assisted coils embolization was preferred to avoid coils migration due to its wide neck. The stent used was the Solitaire AB, which was designed for the treatment of intracranial aneurysms and was used recently in acute stroke as a mechanical thrombectomy device. Complete embolization of the aneurysm was achieved, preserving all the arterial branches without nephrogram defects in the final angiogram.

  11. Abciximab in the treatment of acute in-stent thrombosis in patient with intracranial aneurysm

    International Nuclear Information System (INIS)

    Lilov, M.; Juszkat, R.; Petkov, A.; Todorov, I.

    2009-01-01

    A case of endovascular therapy via embolization of aneurysm in patient with SAH is performed selective brain angiography and find 3 aneurysms. The first is in right segment M1-M2 with diameter 5 mm, the second with wide neck is in supraclinoid portion of right internal carotid artery and the third in left M1-M2 segment. One month after embolization of ruptured aneurysm with coils BALT (Montmorency, France) and previous anticoagulation therapy was applied Leo stent (SALT) intraluminal in left internal carotid artery. Developed acute instent thrombosis recanalized with intraarterial use of abciximab. (authors)

  12. Neck Pain

    Science.gov (United States)

    ... too many hours hunched over your computer or smartphone, often triggers muscle strains. Even minor things, such ... your shoulder. The weight can strain your neck. Sleep in a good position. Your head and neck ...

  13. Versatile fill coils: initial experience as framing coils for oblong aneurysms. A technical case report.

    Science.gov (United States)

    Osanai, Toshiya; Bain, Mark; Hui, Ferdinand K

    2014-01-01

    Coil embolization of oblong aneurysms is difficult because the majority of commercially available coils are manufactured with a helical or spherical tertiary structure. While adopting framing strategies for oblong aneurysms (aspect ratio ≥ 2: 1), traditional coils may be undersized in the long axis but oversized in the short axis, resulting in increased aneurysmal wall stress, risk of re-rupture, and difficulty creating a basket that respects the aneurysmal neck. We review three cases in which versatile filling coils (VFCs) were used as the initial coils for embolization of oblong aneurysms and report coil distribution characteristics and clinical outcomes. Packing density after VFC implantation was assessed using the software AngioSuite-Neuro edition and AngioCalc. a 58-year-old woman experienced a subarachnoid hemorrhage from a ruptured anterior communicating artery aneurysm (7.5 mm × 3.5 mm). A 3-6 mm × 15 cm VFC was selected as the first coil because the flexibility of its wave-loop structure facilitates framing of an irregularly shaped aneurysm. The loop portions of the structures tend to be pressed to the extremes of the aneurysmal sac by the wave component. The VFC was introduced smoothly into the aneurysmal sac without catheter kickback. We were then able to insert detachable filling coils without any adjunctive technique and achieved complete occlusion. Complete occlusion without severe complications was achieved in all three cases in our study. Average packing density after the first coil was 15.63%. VFC coils may have a specific role in framing oblong aneurysms given their complex loop-wave design, allowing spacing of the coils at the dome and neck while keeping sac stress to a minimum.

  14. The Dynamic Locking Blade Plate : innovation in the treatment of femoral neck fractures

    NARCIS (Netherlands)

    Roerdink, W.H.

    2011-01-01

    The scope of this thesis was to describe the design and development of the Dynamic Locking Blade Plate (DLBP), an improved internal fixation (IF) device for intracapsular hip fractures. This thesis focuses on intracapsular hip fractures since the results of current surgical treatment of this type of

  15. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

    International Nuclear Information System (INIS)

    Vilela, Pedro; Goulao, Augusto

    2006-01-01

    Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

  16. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, Pedro; Goulao, Augusto [Garcia de Orta Hospital, Neuroradiology Department, Almada (Portugal)

    2006-08-15

    Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

  17. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft.

    LENUS (Irish Health Repository)

    Molony, David S

    2009-01-01

    BACKGROUND: Abdominal aortic aneurysms (AAA) are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI) is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. METHODS: Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. RESULTS: Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. CONCLUSION: In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  18. Flow stagnation volume and abdominal aortic aneurysm growth: Insights from patient-specific computational flow dynamics of Lagrangian-coherent structures.

    Science.gov (United States)

    Joly, Florian; Soulez, Gilles; Garcia, Damien; Lessard, Simon; Kauffmann, Claude

    2018-01-01

    Abdominal aortic aneurysms (AAA) are localized, commonly-occurring dilations of the aorta. When equilibrium between blood pressure (loading) and wall mechanical resistance is lost, rupture ensues, and patient death follows, if not treated immediately. Experimental and numerical analyses of flow patterns in arteries show direct correlations between wall shear stress and wall mechano-adaptation with the development of zones prone to thrombus formation. For further insights into AAA flow topology/growth interaction, a workout of patient-specific computational flow dynamics (CFD) is proposed to compute finite-time Lyapunov exponents and extract Lagrangian-coherent structures (LCS). This computational model was first compared with 4-D phase-contrast magnetic resonance imaging (MRI) in 5 patients. To better understand the impact of flow topology and transport on AAA growth, hyperbolic, repelling LCS were computed in 1 patient during 8-year follow-up, including 9 volumetric morphologic AAA measures by computed tomography-angiography (CTA). LCS defined barriers to Lagrangian jet cores entering AAA. Domains enclosed between LCS and the aortic wall were considered to be stagnation zones. Their evolution was studied during AAA growth. Good correlation - 2-D cross-correlation coefficients of 0.65, 0.86 and 0.082 (min, max, SD) - was obtained between numerical simulations and 4-D MRI acquisitions in 6 specific cross-sections from 4 patients. In follow-up study, LCS divided AAA lumens into 3 dynamically-isolated zones: 2 stagnation volumes lying in dilated portions of the AAA, and circulating volume connecting the inlet to the outlet. The volume of each zone was tracked over time. Although circulating volume remained unchanged during 8-year follow-up, the AAA lumen and main stagnation zones grew significantly (8 cm 3 /year and 6 cm 3 /year, respectively). This study reveals that transient transport topology can be quantified in patient-specific AAA during disease progression

  19. Unruptured Brain Aneurysms

    Science.gov (United States)

    ... treated with either endovascular coiling or open surgical clipping. However, if the unruptured aneurysm is treated successfully, ... Medical Advisory Board Publications BAF Newsletters Annual Reports News Public Service Announcements Press Releases Blog Administrative Tax ...

  20. New screening system for unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    Samejima, Hirotsugu; Ushikubo, Yukio; Mizokami, Toru

    1990-01-01

    We have designed a screening system to diagnose unruptured aneurysms, including the use of digital subtraction angiography (DSA). We surveyed 115 patients who had undergone clipping procedures after subarachnoid hemorrhage (SAH) and questioned them with regard to the subjective symptoms. Sixty-eight of 92 patients who returned the questionnaire reported, prior to rupture, headache,eye pain, and neck pain most frequently, and also impairment of extraocular movements, ptosis, visual field defects, and motor and sensory disturbances. Nineteen (47.5%) of 40 patients who had complete pain relief after surgery complained of headache from 1 week to 1 month before SAH. In addition, nine patients (22.5%) complained of headache for several years, and were also pain-free after surgery. For the indication of DSA, we employed an expert system based on fuzzy set theory. Seven groups of parameters are: Group 1, a basic questionnaire concerning age, sex, and past and family histories; Group 2, 15 warning signs selected on the basis of retrospective study; and Groups 3-7, detailed questions concerning each sign. Scoring weights assigned to each condition based on the results of the retrospective study, and threshold values were determined by several neurosurgeons. The certainty factors for intermediate hypotheses were calculated from these weights and threshold values and summed up, from which the conclusion was obtained. Twelve new cases of unruptured cerebral aneurysm were diagnosed using this screening system. This system may improve the ability to diagnose cerebral aneurysms before rupture. (author)

  1. Endo-luminal grafting for treatment of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Fu Weiguo; Wang Yuqi; Chen Fuzhen; Ye Jianrong; Wang Jianhua; Yan Zhiping; Cheng Jiemin

    2000-01-01

    Objective: To evaluate the preliminary clinical results of endovascular procedures for abdominal aortic aneurysms (AAA) in a prospective study. Methods: Six patients (average age 70 years, range 56 to 78) with infrarenal AAA were enrolled in Shanghai Zhongshan hospital from February 1998 to February 1999. Computed tomography and angiography were done in every patient for measurement of the length, diameter, and angulation of the proximal and distal AAA necks, aneurysm sac, and common and external iliac arteries. The average diameter of the aneurysm was 6.3 cm (range 4.6 cm to 8.0 cm). The mean proximal neck diameter was 2.0 cm (range 1.8 cm to 2.2 cm) and proximal neck length was 3.0 cm (range 2.5 cm to 3.5 cm). All patients were treated with the endo-luminal grafting for exclusion of AAA. Results: Two tubular and 4 bifurcated endo-grafts were used. All endo-graft procedures were completed successfully. One patient died of renal failure 72 hours after the procedure because of the prolonged operative time and excessive contrast medium. Aortography after the procedure showed the AAA were excluded by endo-graft and no endo-leak in the proximal or distal connections was detected. The patients could take meal and were ambulatory on the first and second postoperative day, respectively. Clinical success (aneurysm exclusion with no death or endo-leak) at 30 days was 83.3%. In the 24 months follow-up in 5 cases, no migration, endo-leak, and increasing aneurysm size were detected with spiral CT or color Duplex ultrasound. Conclusion: Based on initial results and a short term mean follow-up period of 24 months, the endovascular treatment of AAA with stent-graft system is feasible and safe. Further study will be required to observe the long term result in the exclusion of AAA

  2. Aneurysmal Subarachnoid Hemorrhage

    Science.gov (United States)

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome. PMID:25272066

  3. 3D cine phase-contrast MRI at 3T in intracranial aneurysms compared with patient-specific computational fluid dynamics

    NARCIS (Netherlands)

    van Ooij, P.; Schneiders, J. J.; Marquering, H. A.; Majoie, C. B.; van Bavel, E.; Nederveen, A. J.

    2013-01-01

    CFD has been proved valuable for simulating blood flow in intracranial aneurysms, which may add to better rupture risk assessment. However, CFD has drawbacks such as the sensitivity to assumptions needed for the model, which may hinder its clinical implementation. 3D PC-MR imaging is a technique

  4. Comparison of Enterprise with Neuroform stent-assisted coiling of intracranial aneurysms.

    Science.gov (United States)

    Kadkhodayan, Yasha; Rhodes, Nicholas; Blackburn, Spiros; Derdeyn, Colin P; Cross, DeWitte T; Moran, Christopher J

    2013-04-01

    The Enterprise stent is the first closed-cell stent designed to treat wide-necked intracranial aneurysms. Advantages of the design can include improvement in keeping coils within an aneurysm and the ability of the stent to be recaptured. We compared the technical and clinical complications of the Enterprise stent with the open-cell Neuroform stent, its primary alternative. Patients undergoing Enterprise and Neuroform stent-assisted aneurysm coiling were enrolled in prospective registries starting in March 2007 and February 2003, respectively. All consecutive patients through December 2011 were included. Deployment success and difficulty, stent movement and misplacement, and procedural complications were compared. Enterprise deployment success was high (108 of 115 attempts, 93.9%) with 102 aneurysms receiving a stent compared with Neuroform (173 of 214 attempts, 80.8%, p = 0.001) with 163 aneurysms. Enterprise was easier to deploy (1.7% vs 15.9% difficult deployment, p Enterprise stent (8.7% vs 1.4%, p = 0.0021). The Enterprise stent enabled treatment of 10 additional aneurysms that could not be treated with Neuroform and had a higher rate of immediate aneurysm occlusion (87.3% vs 73.0%, p = 0.0058). Enterprise was easier to deploy and enabled treatment of additional aneurysms; however, there were more thromboembolic complications. On the basis of these findings, we prefer to use the Neuroform stent first and rely on the Enterprise stent as an easy-to-deliver backup for stent-assisted coiling.

  5. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms....... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms...... aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated...

  6. A feasibility study of NIR fluorescent image-guided surgery in head and neck cancer based on the assessment of optimum surgical time as revealed through dynamic imaging

    Directory of Open Access Journals (Sweden)

    Yokoyama J

    2013-04-01

    Full Text Available Junkichi Yokoyama,* Mitsuhisa Fujimaki,* Shinichi Ohba, Takashi Anzai, Ryota Yoshii, Shin Ito, Masataka Kojima, Katsuhisa IkedaDepartment of Otolaryngology-Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan *These authors contributed equally to this study Background: In order to minimize surgical stress and preserve organs, endoscopic or robotic surgery is often performed when conducting head and neck surgery. However, it is impossible to physically touch tumors or to observe diffusely invaded deep organs through the procedure of endoscopic or robotic surgery. In order to visualize and safely resect tumors even in these cases, we propose using an indocyanine green (ICG fluorescence method for navigation surgery in head and neck cancer. Objective: To determine the optimum surgical time for tumor resection after the administration of ICG based on the investigation of dynamic ICG fluorescence imaging. Methods: Nine patients underwent dynamic ICG fluorescence imaging for 360 minutes, assessing tumor visibility at 10, 30, 60, 120, 180, and 360 minutes. All cases were scored according to near-infrared (NIR fluorescence imaging visibility scored from 0 to 5. Results: Dynamic NIR fluorescence imaging under the HyperEye Medical System indicated that the greatest contrast in fluorescent images between tumor and normal tissue could be observed from 30 minutes to 1 hour after the administration of ICG. The optimum surgical time was determined to be between 30 minutes to 2 hours after ICG injection. These findings are particularly useful for detection and safe resection of tumors invading the parapharyngeal space. Conclusion: ICG fluorescence imaging is effective for the detection of head and neck cancer. Preliminary findings suggest that the optimum timing for surgery is from 30 minutes to 2 hours after the ICG injection. Keywords: indocyanine green (ICG, navigation surgery, robotic surgery, endoscopic surgery, minimally invasive

  7. A study of the hemodynamics of anterior communicating artery aneurysms

    Science.gov (United States)

    Cebral, Juan R.; Castro, Marcelo A.; Putman, Christopher M.

    2006-03-01

    In this study, the effects of unequal physiologic flow conditions in the internal carotid arteries on the intra-aneurysmal hemodynamics of anterior communicating artery aneurysms were investigated. Patient-specific vascular computational fluid dynamics models of five cerebral aneurysms were constructed from bilateral 3D rotational angiography images. The aneurysmal hemodynamics was analyzed under a range of physiologic flow conditions including the effects of unequal mean flows and phase shifts between the flow waveforms of the left and right internal carotid arteries. A total of five simulations were performed for each patient, and unsteady wall shear stress (WSS) maps were created for each flow condition. Time dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed and used to analyze the influence of the inflow conditions. It was found that mean flow imbalances in the feeding vessels tend to shift the regions of elevated WSS (flow impingement region) towards the dominating inflow jet and to change the magnitude of the WSS peaks. However, the overall qualitative appearance of the WSS distribution and velocity simulations is not substantially affected. In contrast, phase differences tend to increase the temporal complexity of the hemodynamic patterns and to destabilize the intra-aneurysmal flow pattern. However, these effects are less important when the A1 confluence is less symmetric, i.e. dominated by one of the A1 segments. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than one avenue of inflow should be incorporated into flow models.

  8. The Effect of Hemodynamics on Cerebral Aneurysm Morphology

    Science.gov (United States)

    Metcalfe, Ralph; Mantha, Aishwarya; Karmonik, Christof; Strother, Charles

    2004-11-01

    One of the difficulties in applying principles of hemodynamics to the study of blood flow in aneurysms are the drastic variations in possible shape of both the aneurysms and the parent arteries in the region of interest. We have taken data from three para-opthalmic internal carotid artery aneurysms using 3D-digital subtraction angiography (3D-DSA) and performed CFD simulations of steady and unsteady flows through the three different cases using the same pressure gradients and pulsatile flow waveforms (based on the Ku model for flow through the Carotid bifurcation). We have found that the total pressure differential within the aneurysms is consistent with the direction of flow, and that the dynamic pressure gradient within the aneurysm is very small compared with the static pressure variations. Wall shear stresses were highest near regions of sharp arterial curvature, but always remained low inside the aneurysm. These results suggest a more complex role for hemodynamics in aneurysm generation, growth and rupture.

  9. Monitoring early response to chemoradiotherapy with "1"8F-FMISO dynamic PET in head and neck cancer

    International Nuclear Information System (INIS)

    Grkovski, Milan; Beattie, Bradley J.; O'Donoghue, Joseph A.; Humm, John L.; Lee, Nancy Y.; Riaz, Nadeem; Leeman, Jonathan E.; Schoeder, Heiko; Carlin, Sean D.

    2017-01-01

    There is growing recognition that biologic features of the tumor microenvironment affect the response to cancer therapies and the outcome of cancer patients. In head and neck cancer (HNC) one such feature is hypoxia. We investigated the utility of "1"8F-fluoromisonidazole (FMISO) dynamic positron emission tomography (dPET) for monitoring the early microenvironmental response to chemoradiotherapy in HNC. Seventy-two HNC patients underwent FMISO dPET scans in a customized immobilization mask (0-30 min dynamic acquisition, followed by 10 min static acquisitions starting at ∝95 min and ∝160 min post-injection) at baseline and early into treatment where patients have already received one cycle of chemotherapy and anywhere from five to ten fractions of 2 Gy per fraction radiation therapy. Voxelwise pharmacokinetic modeling was conducted using an irreversible one-plasma two-tissue compartment model to calculate surrogate biomarkers of tumor hypoxia (k_3 and Tumor-to-Blood Ratio (TBR)), perfusion (K_1) and FMISO distribution volume (DV). Additionally, Tumor-to-Muscle Ratios (TMR) were derived by visual inspection by an experienced nuclear medicine physician, with TMR > 1.2 defining hypoxia. One hundred and thirty-five lesions in total were analyzed. TBR, k_3 and DV decreased on early response scans, while no significant change was observed for K_1. The k_3 -TBR correlation decreased substantially from baseline scans (Pearson's r = 0.72 and 0.76 for mean intratumor and pooled voxelwise values, respectively) to early response scans (Pearson's r = 0.39 and 0.40, respectively). Both concordant and discordant examples of changes in intratumor k_3 and TBR were identified; the latter partially mediated by the change in DV. In 13 normoxic patients according to visual analysis (all having lesions with TMR = 1.2), subvolumes were identified where k_3 indicated the presence of hypoxia. Pharmacokinetic modeling of FMISO dynamic PET reveals a more detailed characterization of the

  10. Monitoring early response to chemoradiotherapy with {sup 18}F-FMISO dynamic PET in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Grkovski, Milan; Beattie, Bradley J.; O' Donoghue, Joseph A.; Humm, John L. [Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY (United States); Lee, Nancy Y.; Riaz, Nadeem; Leeman, Jonathan E. [Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY (United States); Schoeder, Heiko; Carlin, Sean D. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States)

    2017-09-15

    There is growing recognition that biologic features of the tumor microenvironment affect the response to cancer therapies and the outcome of cancer patients. In head and neck cancer (HNC) one such feature is hypoxia. We investigated the utility of {sup 18}F-fluoromisonidazole (FMISO) dynamic positron emission tomography (dPET) for monitoring the early microenvironmental response to chemoradiotherapy in HNC. Seventy-two HNC patients underwent FMISO dPET scans in a customized immobilization mask (0-30 min dynamic acquisition, followed by 10 min static acquisitions starting at ∝95 min and ∝160 min post-injection) at baseline and early into treatment where patients have already received one cycle of chemotherapy and anywhere from five to ten fractions of 2 Gy per fraction radiation therapy. Voxelwise pharmacokinetic modeling was conducted using an irreversible one-plasma two-tissue compartment model to calculate surrogate biomarkers of tumor hypoxia (k{sub 3} and Tumor-to-Blood Ratio (TBR)), perfusion (K{sub 1}) and FMISO distribution volume (DV). Additionally, Tumor-to-Muscle Ratios (TMR) were derived by visual inspection by an experienced nuclear medicine physician, with TMR > 1.2 defining hypoxia. One hundred and thirty-five lesions in total were analyzed. TBR, k{sub 3} and DV decreased on early response scans, while no significant change was observed for K{sub 1}. The k{sub 3} -TBR correlation decreased substantially from baseline scans (Pearson's r = 0.72 and 0.76 for mean intratumor and pooled voxelwise values, respectively) to early response scans (Pearson's r = 0.39 and 0.40, respectively). Both concordant and discordant examples of changes in intratumor k{sub 3} and TBR were identified; the latter partially mediated by the change in DV. In 13 normoxic patients according to visual analysis (all having lesions with TMR = 1.2), subvolumes were identified where k{sub 3} indicated the presence of hypoxia. Pharmacokinetic modeling of FMISO dynamic PET

  11. Monitoring early response to chemoradiotherapy with 18F-FMISO dynamic PET in head and neck cancer.

    Science.gov (United States)

    Grkovski, Milan; Lee, Nancy Y; Schöder, Heiko; Carlin, Sean D; Beattie, Bradley J; Riaz, Nadeem; Leeman, Jonathan E; O'Donoghue, Joseph A; Humm, John L

    2017-09-01

    There is growing recognition that biologic features of the tumor microenvironment affect the response to cancer therapies and the outcome of cancer patients. In head and neck cancer (HNC) one such feature is hypoxia. We investigated the utility of 18 F-fluoromisonidazole (FMISO) dynamic positron emission tomography (dPET) for monitoring the early microenvironmental response to chemoradiotherapy in HNC. Seventy-two HNC patients underwent FMISO dPET scans in a customized immobilization mask (0-30 min dynamic acquisition, followed by 10 min static acquisitions starting at ∼95 min and ∼160 min post-injection) at baseline and early into treatment where patients have already received one cycle of chemotherapy and anywhere from five to ten fractions of 2 Gy per fraction radiation therapy. Voxelwise pharmacokinetic modeling was conducted using an irreversible one-plasma two-tissue compartment model to calculate surrogate biomarkers of tumor hypoxia (k 3 and Tumor-to-Blood Ratio (TBR)), perfusion (K 1 ) and FMISO distribution volume (DV). Additionally, Tumor-to-Muscle Ratios (TMR) were derived by visual inspection by an experienced nuclear medicine physician, with TMR > 1.2 defining hypoxia. One hundred and thirty-five lesions in total were analyzed. TBR, k 3 and DV decreased on early response scans, while no significant change was observed for K 1 . The k 3 -TBR correlation decreased substantially from baseline scans (Pearson's r = 0.72 and 0.76 for mean intratumor and pooled voxelwise values, respectively) to early response scans (Pearson's r = 0.39 and 0.40, respectively). Both concordant and discordant examples of changes in intratumor k 3 and TBR were identified; the latter partially mediated by the change in DV. In 13 normoxic patients according to visual analysis (all having lesions with TMR = 1.2), subvolumes were identified where k 3 indicated the presence of hypoxia. Pharmacokinetic modeling of FMISO dynamic PET reveals a more detailed

  12. Giant true celiac artery aneurysm

    International Nuclear Information System (INIS)

    Aljabri, Badr

    2009-01-01

    Celiac artery aneurysms are rare and usually asymptomatic. The management of these aneurysms is challenging, especially when they are large and involve the confluence of the trifurcation. We present here a case of a large celiac artery aneurysm involving its branches in a young woman. Preoperative investigations, intraoperative findings, and the operative procedure are also presented and discussed. (author

  13. Comparison of 3D TOF-MRA and 3D CE-MRA at 3 T for imaging of intracranial aneurysms

    International Nuclear Information System (INIS)

    Cirillo, Mario; Scomazzoni, Francesco; Cirillo, Luigi; Cadioli, Marcello; Simionato, Franco; Iadanza, Antonella; Kirchin, Miles; Righi, Claudio; Anzalone, Nicoletta

    2013-01-01

    Purpose: To compare 3 T elliptical-centric CE MRA with 3 T TOF MRA for the detection and characterization of unruptured intracranial aneurysms (UIAs), by using digital subtracted angiography (DSA) as reference. Materials and methods: Twenty-nine patients (12 male, 17 female; mean age: 62 years) with 41 aneurysms (34 saccular, 7 fusiform; mean diameter: 8.85 mm [range 2.0–26.4 mm]) were evaluated with MRA at 3 T each underwent 3D TOF-MRA examination without contrast and then a 3D contrast-enhanced (CE-MRA) examination with 0.1 mmol/kg bodyweight gadobenate dimeglumine and k-space elliptic mapping (Contrast ENhanced Timing Robust Angiography [CENTRA]). Both TOF and CE-MRA images were used to evaluate morphologic features that impact the risk of rupture and the selection of a treatment. Almost half (20/41) of UIAs were located in the internal carotid artery, 7 in the anterior communicating artery, 9 in the middle cerebral artery and 4 in the vertebro-basilar arterial system. All patients also underwent DSA before or after the MR examination. Results: The CE-MRA results were in all cases consistent with the DSA dataset. No differences were noted between 3D TOF-MRA and CE-MRA concerning the detection and location of the 41 aneurysms or visualization of the parental artery. Differences were apparent concerning the visualization of morphologic features, especially for large aneurysms (>13 mm). An irregular sac shape was demonstrated for 21 aneurysms on CE-MRA but only 13/21 aneurysms on 3D TOF-MRA. Likewise, CE-MRA permitted visualization of an aneurismal neck and calculation of the sac/neck ratio for all 34 aneurysms with a neck demonstrated at DSA. Conversely, a neck was visible for only 24/34 aneurysms at 3D TOF-MRA. 3D CE-MRA detected 15 aneurysms with branches originating from the sac and/or neck, whereas branches were recognized in only 12/15 aneurysms at 3D TOF-MRA. Conclusion: For evaluation of intracranial aneurysms at 3 T, 3D CE-MRA is superior to 3D TOF

  14. Therapeutic effect of enterprise stent-assisted embolization for very small ruptured intracranial aneurysms.

    Science.gov (United States)

    Qin, Feiyun; Li, Zhenbao; Fang, Xinggen; Zhao, Xintong; Liu, Jiaqiang; Wu, Degang; Lai, Niansheng

    2017-08-01

    Enterprise stent has been widespread used in wide-necked intracranial aneurysms and good efficacy has been achieved, but there are few reports on its applications in very small ruptured intracranial aneurysms in literatures. This study aimed to evaluate the safety and efficacy of Enterprise stent-assisted coiling embolization of very small ruptured intracranial aneurysms.We retrospectively reviewed the clinical and imaging data from 37 patients with very small ruptured intracranial aneurysms who had SAC using Enterprise stents performed from February 2012 to July 2016 in our department. Data collected and analyzed included patient demographics, morphologic features of the aneurysm, treatment results, and follow-up results. Clinical outcomes were evaluated by the Glasgow Outcome Scale (GOS).Enterprise stents were successfully implanted in all 37 patients with very small ruptured intracranial aneurysms. Of the 37 individuals, 28 patients exhibited complete occlusion at Raymond grade I, 5 patients exhibited occlusion at Raymond grade II, and 4 patients at Raymond grade III. Procedure-related complications occurred in 3 of 37 patients (8.1%), including 1 case of intraprocedure aneurysm rupture who died from cerebral herniation caused by severe postoperative cerebral ischemia during the hospital stay, and the other 2 complications were acute in-stent thrombosis, and occlusion of parent artery caused by falling-off internal carotid artery plaque, respectively. A total of 36 patients underwent postoperative clinical follow-up visits for 6 to 24 months of which 31 patients recovered (GOS ≥ 4). One patient had hemiplegic paralysis, and no rehemorrhage was found. A total of 25 patients underwent follow-up digital subtraction angiography (DSA) at 3-21 months postintervention, in whom there were 22 cases with complete occlusion, 2 cases with recurrence of aneurysm neck, and 1 case with in-stent restenosis, but there was no patient with neurologic deficits.The Enterprise

  15. Quantifying the Dynamics of Field Cancerization in Tobacco-Related Head and Neck Cancer: A Multiscale Modeling Approach.

    Science.gov (United States)

    Ryser, Marc D; Lee, Walter T; Ready, Neal E; Leder, Kevin Z; Foo, Jasmine

    2016-12-15

    High rates of local recurrence in tobacco-related head and neck squamous cell carcinoma (HNSCC) are commonly attributed to unresected fields of precancerous tissue. Because they are not easily detectable at the time of surgery without additional biopsies, there is a need for noninvasive methods to predict the extent and dynamics of these fields. Here, we developed a spatial stochastic model of tobacco-related HNSCC at the tissue level and calibrated the model using a Bayesian framework and population-level incidence data from the Surveillance, Epidemiology, and End Results (SEER) registry. Probabilistic model analyses were performed to predict the field geometry at time of diagnosis, and model predictions of age-specific recurrence risks were tested against outcome data from SEER. The calibrated models predicted a strong dependence of the local field size on age at diagnosis, with a doubling of the expected field diameter between ages at diagnosis of 50 and 90 years, respectively. Similarly, the probability of harboring multiple, clonally unrelated fields at the time of diagnosis was found to increase substantially with patient age. On the basis of these findings, we hypothesized a higher recurrence risk in older than in younger patients when treated by surgery alone; we successfully tested this hypothesis using age-stratified outcome data. Further clinical studies are needed to validate the model predictions in a patient-specific setting. This work highlights the importance of spatial structure in models of epithelial carcinogenesis and suggests that patient age at diagnosis may be a critical predictor of the size and multiplicity of precancerous lesions. Cancer Res; 76(24); 7078-88. ©2016 AACR. ©2016 American Association for Cancer Research.

  16. Morphological and hemodynamic analysis of mirror posterior communicating artery aneurysms.

    Directory of Open Access Journals (Sweden)

    Jinyu Xu

    Full Text Available BACKGROUND AND PURPOSE: Hemodynamic factors are commonly believed to play an important role in the pathogenesis, progression, and rupture of cerebral aneurysms. In this study, we aimed to identify significant hemodynamic and morphological parameters that discriminate intracranial aneurysm rupture status using 3-dimensional-angiography and computational fluid dynamics technology. MATERIALS AND METHODS: 3D-DSA was performed in 8 patients with mirror posterior communicating artery aneurysms (Pcom-MANs. Each pair was divided into ruptured and unruptured groups. Five morphological and three hemodynamic parameters were evaluated for significance with respect to rupture. RESULTS: The normalized mean wall shear stress (WSS of the aneurysm sac in the ruptured group was significantly lower than that in the unruptured group (0.52±0.20 versus 0.81±0.21, P = .012. The percentage of the low WSS area in the ruptured group was higher than that in the unruptured group (4.11±4.66% versus 0.02±0.06%, P = .018. The AR was 1.04±0.21 in the ruptured group, which was significantly higher than 0.70±0.17 in the unruptured group (P = .012. By contrast, parameters that had no significant differences between the two groups were OSI (P = .674, aneurysm size (P = .327, size ratio (P = .779, vessel angle (P = 1.000 and aneurysm inclination angle (P = 1.000. CONCLUSIONS: Pcom-MANs may be a useful disease model to investigate possible causes of aneurysm rupture. The ruptured aneurysms manifested lower WSS, higher percentage of low WSS area, and higher AR, compared with the unruptured one. And hemodynamics is as important as morphology in discriminating aneurysm rupture status.

  17. Giant intracranial aneurysm embolization with a yield stress fluid material: insights from CFD analysis.

    Science.gov (United States)

    Wang, Weixiong; Graziano, Francesca; Russo, Vittorio; Ulm, Arthur J; De Kee, Daniel; Khismatullin, Damir B

    2013-01-01

    The endovascular treatment of intracranial aneurysms remains a challenge, especially when the aneurysm is large in size and has irregular, non-spherical geometry. In this paper, we use computational fluid dynamics to simulate blood flow in a vertebro-basilar junction giant aneurysm for the following three cases: (1) an empty aneurysm, (2) an aneurysm filled with platinum coils, and (3) an aneurysm filled with a yield stress fluid material. In the computational model, blood and the coil-filled region are treated as a non-Newtonian fluid and an isotropic porous medium, respectively. The results show that yield stress fluids can be used for aneurysm embolization provided the yield stress value is 20 Pa or higher. Specifically, flow recirculation in the aneurysm and the size of the inflow jet impingement zone on the aneurysm wall are substantially reduced by yield stress fluid treatment. Overall, this study opens up the possibility of using yield stress fluids for effective embolization of large-volume intracranial aneurysms.

  18. Analysis of blood flow patterns in aortic aneurysm by cine magnetic resonance imaging

    International Nuclear Information System (INIS)

    Matsuoka, Hiroshi

    1993-01-01

    Cine MRI (0.5 T) using rephased gradient echo technique was performed to study the patterns of blood flow in the aortic aneurysm of 16 patients with aortic aneurysm, and the data were compared with those of 5 healthy volunteers. In the transaxial section, the blood flow in normal aorta appeared as homogeneous high intensity during systole. On the other hand, the blood flow in the aneurysm appeared as inhomogeneous flow enhancement with flow void. In the sagittal scan, the homogeneous flow enhancement in a normal aorta was also observed during systole and its apex of flow enhancement was 'taper'. The blood flow patterns in the aneurysm were classified as 'irregular', 'zonal', 'eddy', and 'obscure' depending on the contrast of flow enhancement and flow void. Their apexes were 'taper' or 'round'. The blood flow patterns in the aneurysm were related to the size of aneurysm. In patients with a large size 'aneurysm, their flow patterns were 'eddy' or 'obscure' and the flow enhancement was 'round'. On the other hand, in patients with a small size aneurysm, their flow patterns were 'irregular' or 'zonal', and their flow enhancement was 'taper'. Though the exact mechanism of abnormal flow patterns in an aortic aneurysm remains to be determined, cine MRI gives helpful informations in assessing blood flow dynamics in the aneurysm. (author)

  19. A proposal for standardizing computed tomography reports on abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Torlai, Fabiola Goda; Meirelles, Gustavo S. Portes; Miranda Junior, Fausto; Fonseca, Jose Honorio A.P. da; Ajzen, Sergio; D'Ippolito, Giuseppe

    2006-01-01

    Objective: to propose a model to standardize computed tomography reports on abdominal aortic aneurysms. Materials and methods: interviews were carried out with members of the Vascular Surgery Division of our institution, in the period between April and October 2004, aiming at developing a standardized model of computed tomography reports on abdominal aortic aneurysms. Based on this model, a questionnaire was elaborated and sent to other nine surgeons, all of them experienced in the field of abdominal aortic surgery. The questionnaires response rate was 55.5% (5/9). Results: the most frequently mentioned parameters of interest for evaluation of abdominal aortic aneurysms were: maximum diameter of proximal aortic neck, proximal aortic neck length to lower renal arteries, shape of proximal aortic neck, maximum diameter of the aneurysm and diameter of the common iliac arteries. These data allowed the development of a proposal for a model to standardize computed tomography reports. Conclusion: a model for standardized tomographic analysis of abdominal aortic aneurysms has met vascular surgeons' needs for following-up patients and planning their treatment. (author)

  20. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications.

    Science.gov (United States)

    Bryce, Yolanda; Rogoff, Philip; Romanelli, Donald; Reichle, Ralph

    2015-01-01

    Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR. (©)RSNA, 2015.

  1. Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: Technical note

    Directory of Open Access Journals (Sweden)

    Shunsuke Kakino

    2008-08-01

    Full Text Available Shunsuke Kakino, Kuniaki Ogasawara, Yoshitaka Kubo, Hideaki Nishimoto, Akira OgawaDepartment of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, JapanAbstract: The subtemporal approach with division of the posterior communicating artery (PcomA is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.Keywords: basilar tip aneurysm, subtemporal approach, posterior communicating artery

  2. CT during selective arteriography: anatomical assessment of unruptured intracranial aneurysms before endovascular treatment

    International Nuclear Information System (INIS)

    Nomura, M.; Kida, S.; Uchiyama, N.; Yamashima, T.; Yamashita, J.; Sanada, J.; Yoshikawa, J.; Matsui, O.

    2001-01-01

    Our aim was to investigate the usefulness of helical CT during selective angiography (CT arteriography) in pretreatment assessment of unruptured intracranial aneurysms. We studied 47 unruptured aneurysms in 34 prospectively recruited patients for whom endovascular embolisation was initially considered. As pretreatment assessment, we performed rotational digital subtraction angiography (DSA) followed by CT arteriography. The findings on axial source images (axial images) and reconstructed three-dimensional CT angiography (3D-CTA) of CT arteriography were compared to those of rotational DSA, with particular attention to the neck of the aneurysm and arterial branches adjacent to it. Information provided by CT arteriography was more useful than that of rotational DSA as regards the neck in 25 (53 %) of 47 cases and as regards branches in 18 (49 %) of 37 aneurysms. On axial images, small arteries such as the anterior choroidal artery were seen in some cases. CT arteriography can provide valuable additional information about unruptured aneurysms, which cannot be obtained by rotational DSA alone. This technique is useful for obtaining anatomical information about aneurysm anatomy and for deciding the therapeutic strategy. (orig.)

  3. Neck Pain

    Science.gov (United States)

    ... Vomiting Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath ... worse or doesn’t get better. Start OverDiagnosisYour pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  4. Developing a new endograft for the treatment of juxtarenal aortic aneurysms: definition and experimentation

    Directory of Open Access Journals (Sweden)

    Sergio Q. Belczak

    2015-06-01

    Full Text Available OBJECTIVES: To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft. METHODS: A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50-60 kg to assess the new endograft model. RESULTS: The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility. CONCLUSIONS: The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms.

  5. Stent-assisted coil embolization of aneurysms with small parent vessels: safety and efficacy analysis.

    Science.gov (United States)

    Kühn, Anna Luisa; Hou, Samuel Y; Puri, Ajit S; Silva, Christine F; Gounis, Matthew J; Wakhloo, Ajay K

    2016-06-01

    Stent-assisted coil embolization (SACE) is a viable therapeutic approach for wide-neck intracranial aneurysms. However, it can be technically challenging in small cerebral vessels (≤2 mm). To present our experience with stents approved for SACE in aneurysms with small parent arteries. All patients who underwent stent-assisted aneurysm treatment with either a Neuroform or an Enterprise stent device at our institution between June 2006 and October 2012 were identified. Additionally, we evaluated each patient's vascular risk factors, aneurysm characteristics (ruptured vs non-ruptured, incidental finding, recanalized) and follow-up angiography data. A total of 41 patients with 44 aneurysms met our criteria, including 31 women and 10 men. Most of the aneurysms were located in the anterior circulation (75%). Stent placement in vessels 1.2-2 mm in diameter was successful in 93.2%. Thromboembolic complications occurred in 6 cases and vessel straightening was seen in 1 case only. Initial nearly complete to complete aneurysm obliteration was achieved in 88.6%. Six-month follow-up angiography showed coil compaction in three cases, one asymptomatic in-stent stenosis and stent occlusion. Twelve to 20-months' follow-up showed stable coil compaction in two patients compared with previous follow-up, and aneurysm recanalization in two patients. Twenty-four to 36-months' follow-up showed further coil compaction in one of these patients and aneurysm recanalization in a previous case of stable coil compaction on mid-term follow-up. Our results suggest that SACE of aneurysms with small parent vessels is feasible in selected cases and shows good long-term patency rates of parent arteries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Should indications for WEB aneurysm treatment be enlarged? Report of a series of 20 patients with aneurysms in "atypical" locations for WEB treatment.

    Science.gov (United States)

    Pierot, L; Biondi, A; Narata, A-P; Mihalea, C; Januel, A-C; Metaxas, G; Bibi, R; Caroff, J; Soize, S; Cognard, C; Spelle, L; Herbreteau, D

    2017-06-01

    Flow disruption with the WEB device is an innovative technique for the endovascular treatment of wide neck bifurcation aneurysms. Good clinical practice trials have shown high safety of this treatment with good efficacy. Technical developments (single layer devices and smaller microcatheters) facilitate the treatment, potentially leading to enlargement of indications. This series is collecting aneurysms in "atypical" locations for WEB treatment and analyzing safety and efficacy of this treatment. In each participating center, patients with aneurysms treated with WEB were prospectively included in a local database. Patients treated for aneurysms in "atypical" locations were extracted. Patient and aneurysm characteristics, intraoperative complications, and anatomical results at the end of the procedure and at last follow-up were collected and analyzed. Five French neurointerventional centers included 20 patients with 20 aneurysms in "atypical" locations for WEB treatment treated with WEB. Aneurysm locations were ICA carotid-ophthalmic in 9 aneurysms (45.0%), ICA posterior communicating in 4 (20.0%), Pericallosal artery in 5 (25.0%), and basilar artery between P1 and superior cerebellar artery in 2 (10.0%). There were no complications (thromboembolic or intraoperative rupture) in this series. At follow-up (mean: 7.4 months), adequate occlusion was obtained in 100.0% of aneurysms. This series confirms that it is possible to enlarge indications of WEB treatment to "atypical" locations with good safety and efficacy. These data have to be confirmed in large prospective series. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Endovascular treatment of experimentally induced aneurysms in rabbits using stents: a feasibility study

    International Nuclear Information System (INIS)

    Hans, F.J.; Thiex, R.; Gilsbach, J.M.; Krings, T.; Moeller-Hartmann, W.; Dreeskamp, H.; Stein, K.P.; Meetz, A.; Thron, A.; Pfeffer, J.; Scherer, K.; Brunn, A.

    2003-01-01

    Although Guglielmi detachable coil (GDC) systems have been generally accepted for treatment of intracranial aneurysms, primary stenting of aneurysms using porous stents or implantation of coils after stent placement remains experimental. Testing of these new methods requires an animal model which imitates human aneurysms in size, configuration and neck morphology. We assessed in detail the technical requirements of and steps for transfemoral stent treatment of experimentally induced aneurysms at the top of the brachiocephalic trunk in rabbits. We created aneurysms in ten rabbits by distal ligation and intraluminal digestion of the right common carotid artery with elastase. We treated five animals with porous stents alone, and five with stents plus coiling via the meshes of the stent, which permitted dense packing of coils. No complications related to the procedures occurred. In all animals, even in those treated solely with porous stents, total occlusion of the aneurysm was achieved. Our animal model can be suitable for testing the biocompatibility and occlusion rate of new methods and devices for the treatment of experimental aneurysms. (orig.)

  8. Management of ruptured anterior communicating artery aneurysms presenting with sudden paraplegia

    Directory of Open Access Journals (Sweden)

    Jiu-hong MA

    2016-10-01

    Full Text Available Objective  To explore the causes of ruptured anterior communicating artery aneurysms presenting with paraplegia, and summarize the key points of diagnosis and treatment methods. Methods  A total of 260 patients with ruptured anterior communicating artery aneurysms were received medical treatment in the Department of Neurosurgery, Shanxi Provincial People's Hospital from Jan. 2012 to Mar. 2015. Of which 6 patients were clinically presented with paraplegia, their clinical data including CT/MR/DSA were retrospectively analyzed, and based on the analysis, aneurysm embolization and anti-vasospasm treatment were performed. Results  Besides headache and discomfort in the neck, 5 of the 6 patients were with double lower limbs paraplegia, and the another one presented quadriplegia. By symptomatic treatment of aneurysm embolization and anti vasospasm, the myodynamia of the paraplegic limbs recovered from 0-Ⅰto Ⅳ-Ⅴgrade, and 2 of the 6 patients spent a shorter recovery time (about 2 weeks, the other 4 recovered in 3 months. The limbs myodynamia of the 6 patients recovered completely in half-and one year follow up. Conclusions  The mechanism of ruptured anterior communicating artery aneurysms presenting with paraplegia may be the insufficient blood supply to the primary motor area and supplementary motor area (SMA of brain cortex caused by aneurysms rupture. Aneurysm embolization should be performed in clinical treatment, supplemented with anti vasospasm and symptomatic treatment of improving neurological function. DOI: 10.11855/j.issn.0577-7402.2016.09.14

  9. Large Renal Artery Aneurysm Treated with Guglielmi Detachable Coils: Procedural and 4-Year Follow-up Results

    International Nuclear Information System (INIS)

    Damascelli, Bruno; Bartorelli, Antonio L.; Ticha, Vladimira; Trabattoni, Daniela; Lanocita, Rodolfo

    2008-01-01

    A large aneurysm of the left renal artery was found incidentally during abdominal ultrasound in a 39-year-old woman with no medical or family history of cardiovascular disease. Vascular pathology with a dysplastic appearance was confirmed by magnetic resonance angiography and the patient was offered transcatheter embolization. Since the position and size of the neck of the aneurysm could not be determined at angiography, detachable platinum coils were used for occlusion. The procedure was performed without complications. During a 4-year follow-up no alterations of renal function, recanalization of the aneurysm, or perfusion defects in the rest of the left renal circulation were noted.

  10. Modified use of a dynamic bite opener--treatment and prevention of trismus in a child with head and neck cancer: a case report.

    Science.gov (United States)

    Dijkstra, P U; Kropmans, T J; Tamminga, R Y

    1992-10-01

    Trismus may be a complication arising during or after treatment of patients with head and neck cancer. Treatment of trismus is difficult, making prevention very important. To prevent and treat trismus in a patient with a nasopharyngeal tumor, the Contract-Relax-Antagonist-Contract (CRAC) technique was applied, with the aid of a custom-made dynamic bite opener (DBO). The CRAC technique in combination with the DBO, as a therapy/prevention program for trismus, is not referred to in the literature. The combination of CRAC and DBO appeared to be a gentle and effective method well tolerated by the patient.

  11. Pulmonary artery aneurysm

    African Journals Online (AJOL)

    Enrique

    Introduction. Pulmonary artery aneurysms are a rare finding in general radiological practice. The possible causes are myriad and diverse in pathophysiolo- gy. Patients with post-stenotic dilata- tion of the main pulmonary artery usually present fairly late with insidi- ous cardiorespiratory symptoms. Diagnosis requires ...

  12. Brain Aneurysm: Recovery

    Science.gov (United States)

    ... people, but they are growing larger as medical technology continues to grow and early detection and treatment becomes more prevalent. Read More “I’ve met many people through The Brain Aneurysm Foundation. Each one with their own unique story. Of survival, of appreciation for what we still ...

  13. Assessment of the signal intensity distribution pattern within the unruptured cerebral aneurysms using color-coded 3D MR angiography

    International Nuclear Information System (INIS)

    Satoh, Toru; Omi, Megumi; Ohsako, Chika

    2005-01-01

    To evaluate the interaction between the MR signal intensity distribution pattern and bleb formation/deformation of the aneurysmal dome, fifty cases of the unruptured cerebral aneurysms were investigated with the color-coded 3D MR angiography. Patterns were categorized into central-type, neck-type and peripheral-type according to the distribution of MR signals with low-, moderate- and high signal intensity areas. Imaging analysis revealed the significant relationship (P<0.02) of the peripheral-type aneurysms to the bleb formation and deformation of the dome, compared with those of central- and neck-type. Additionally, peripheral-type signal intensity distribution pattern was shown with aneurysms harboring relatively large dome size and lateral-type growth including internal carotid aneurysms. Prospective analysis of intraaneurysmal flow pattern with the color-coded 3D MR angiography may provide patient-specific analysis of intraaneurysmal flow status in relation to the morphological change of the corresponding aneurysmal dome in the management of unruptured cerebral aneurysms. (author)

  14. Multimodal imaging in the elastase-induced aneurysm model in rabbits: a comparative study using serial DSA, MRA and CTA

    International Nuclear Information System (INIS)

    Doerfler, A.; Becker, W.; Wanke, I.; Goericke, S.; Oezkan, N.; Forsting, M.

    2004-01-01

    Background and Purpose: The elastase-induced aneurysm model in rabbits has proved to be suitable for testing new endovascular occlusion devices. The purpose of this study was to evaluate different imaging modalities for the depiction of anatomy and size of elastase-induced aneurysms and for serial follow-up imaging. Materials and Methods: Elastase-induced aneurysms were created in eight Chinchilla bastard rabbits by endoluminal incubation of porcine elastase. Serial imaging was performed using intravenous DSA (IVDSA), contrast-enhanced MRA (CEMRA), and time-of-flight MRA (TOF) 14 days, 4 weeks and 3 months after aneurysm creation. Intraarterial DSA (IADSA) and CT angiography (CTA) were performed after 3 months. Aneurysm size and geometry (height H, width W, neck width N) were compared. Results: On IVDSA after two weeks mean aneurysm height was 6.2 mm (range 2.8-11.0 mm), mean aneurysm neck width was 2.7 mm (range 2.0-4.2 mm) and mean aneurysm neck width was 2.7 mm (range 2.0-4.2 mm). We did not observed any statistically significant change in aneurysm dimensions during follow-up at 4 weeks (CEMRA: H: 5.4, W: 2.4, N: 2.4; TOF: H: 5.7, W: 2.4, N: 2.7) and 3 months (CEMRA: H: 5.8, W: 2.6, N: 2.6; TOF: H: 6.9, W: 2.8, N: 3.0). Aneurysm dimensions could be best seen on IADSA (H: 6.2, W: 3.0, N: 2.7) with good correlation to CTA (r=0.94; H: 6.1, W: 2.8, N: 2.6), CE-MRA (r=0.92), and TOF (r=0.97). TOF was superior to CEMRA in delineating the aneurysm wall. Conclusions: Serial imaging using MRA, CTA or intravenous and intraarterial angiography is feasible in the elastase-induced aneurysm model. Contrast-enhanced MRA, TOF-MRA and CTA showed good correlation to IADSA and are all suitable for non-invasive pretherapeutic measurement of aneurysm size. (orig.) [de

  15. Three dimensional CT angiography (3D-CTA) in ruptured aneurysm surgery on acute stage

    International Nuclear Information System (INIS)

    Matsumoto, Masato; Endo, Yuji; Nakano, Masayuki

    1998-01-01

    We evaluated three-dimensional CT angiography (3D-CTA) for the treatment of acutely ruptured cerebral aneurysms. Sixty patients with subarachnoid hemorrhage from cerebral aneurysms were investigated both by 3D-CTA and conventional angiography and 26 patients were studied using 3D-CTA without conventional angiography. In the 60 cases, both 3D-CTA and the conventional angiography revealed 100% accuracy in diagnosing ruptured aneurysms, and 3D-CTA and the conventional angiography showed 96% and 92% accuracy for unruptured aneurysms respectively. 3D-CTA was equal or superior to the conventional angiography. Based on these data, since December, 1996, we have operated on 26 consecutive patients with ruptured aneurysms located in the anterior circulation of the circle of Willis, using 3D-CTA without conventional angiography. Thirty-one aneurysms, including 5 associated unruptured aneurysms, were visualized by 3D-CTA and verified at surgery. All aneurysms were clipped successfully. We think that it will be possible to operate on most ruptured aneurysms using only 3D-CTA without the conventional angiography except for the cases of the following situations: if a cerebral infarction is present, conventional angiography is required to evaluate for a stenotic or occlusive lesion of the intracranial arteries, cervical carotid, or vertebral arteries; in cases of giant or large aneurysms, the dynamic information provided by the conventional angiography is needed in case bypass surgery is necessary; and for aneurysms close to bony structures, such as an internal carotid-ophthalmic artery aneurysm, conventional angiography is necessary. (author)

  16. Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research

    Directory of Open Access Journals (Sweden)

    Arnau Benet

    2015-01-01

    Full Text Available Aim. To evaluate the feasibility of implanting 3D-printed brain aneurysm model in human cadavers and to assess their utility in neurosurgical research, complex case management/planning, and operative training. Methods. Two 3D-printed aneurysm models, basilar apex and middle cerebral artery, were generated and implanted in four cadaveric specimens. The aneurysms were implanted at the same anatomical region as the modeled patient. Pterional and orbitozygomatic approaches were done on each specimen. The aneurysm implant, manipulation capabilities, and surgical clipping were evaluated. Results. The 3D aneurysm models were successfully implanted to the cadaveric specimens’ arterial circulation in all cases. The features of the neck in terms of flexibility and its relationship with other arterial branches allowed for the practice of surgical maneuvering characteristic to aneurysm clipping. Furthermore, the relationship of the aneurysm dome with the surrounding structures allowed for better understanding of the aneurysmal local mass effect. Noticeably, all of these observations were done in a realistic environment provided by our customized embalming model for neurosurgical simulation. Conclusion. 3D aneurysms models implanted in cadaveric specimens may represent an untapped training method for replicating clip technique; for practicing certain approaches to aneurysms specific to a particular patient; and for improving neurosurgical research.

  17. Neck pain

    Science.gov (United States)

    ... cause of neck pain is muscle strain or tension. Most often, everyday activities are to blame. Such ... of a heart attack , such as shortness of breath, sweating, nausea, vomiting, or arm or jaw pain. ...

  18. Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms

    International Nuclear Information System (INIS)

    Dinc, Hasan; Kuzeyli, Kayhan; Kosucu, Polat; Sari, Ahmet; Cekirge, Saruhan

    2006-01-01

    One of the feared complications during detachable coil embolization of cerebral aneurysms is herniation of a coil loop into the parent artery. Although coil protrusion of one or two loops into the parent vessel may not cause adverse events and in some instances can be ignored, the authors believe that coil retrieval is indicated if a free end is seen pulsating along the blood flow stream to prevent migration of the entire coil mass. In one patient, a microballoon was inflated across the neck of the aneurysm during retrieval of a herniated coil to prevent further coil herniation from the aneurysm sac. We present two cases in which prolapsed coils were successfully retrieved either using a microsnare and balloon combination or a microsnare alone. This report focuses on the efficacy of the Amplatz microsnare for such retrievals and the circumstances in which a herniated coil needs to be retrieved. We report two cases in which embolization coils partially migrated into the parent artery during endovascular treatment of cerebral aneurysm and were retrieved using the Amplatz Nitinol microsnare. (orig.)

  19. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge; Grønbæk, Morten

    2013-01-01

    BACKGROUND: We determined the predictive power of tobacco smoking on aortic aneurysm as opposed to other risk factors in the general population. METHODS: We recorded tobacco smoking and other risk factors at baseline, and assessed hospitalization and death from aortic aneurysm in 15,072 individuals...... aneurysm in males and females consuming above 20g tobacco daily was 3.5% and 1.3%, among those >60years with plasma cholesterol >5mmol/L and a systolic blood pressure >140mmHg. CONCLUSIONS: Tobacco smoking is the most important predictor of future aortic aneurysm outcomes in the general population...

  20. Parallel multiscale simulations of a brain aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Grinberg, Leopold [Division of Applied Mathematics, Brown University, Providence, RI 02912 (United States); Fedosov, Dmitry A. [Institute of Complex Systems and Institute for Advanced Simulation, Forschungszentrum Jülich, Jülich 52425 (Germany); Karniadakis, George Em, E-mail: george_karniadakis@brown.edu [Division of Applied Mathematics, Brown University, Providence, RI 02912 (United States)

    2013-07-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multiscale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier–Stokes solver NεκTαr. The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers (NεκTαr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300 K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in

  1. Parallel multiscale simulations of a brain aneurysm

    International Nuclear Information System (INIS)

    Grinberg, Leopold; Fedosov, Dmitry A.; Karniadakis, George Em

    2013-01-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multiscale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier–Stokes solver NεκTαr. The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers (NεκTαr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300 K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in

  2. Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki.

    Science.gov (United States)

    Thiarawat, Peeraphong; Jahromi, Behnam Rezai; Kozyrev, Danil A; Intarakhao, Patcharin; Teo, Mario K; Choque-Velasquez, Joham; Hernesniemi, Juha

    2017-05-01

    The objectives of this study were to analyze microsurgical techniques and to determine correlations between microsurgical techniques and the radiographic findings in the microneurosurgical treatment of posterior communicating artery aneurysms (PCoAAs). We retrospectively analyzed radiographic findings and videos of surgeries in 64 patients with PCoAAs who underwent microsurgical clipping by the senior author from August 2010 to 2014. From 64 aneurysms, 30 (47%) had acute subarachnoid hemorrhage (SAH) that necessitated lamina terminalis fenestration (odds ratio [OR], 67.67; P < 0.001) and Liliequist membrane fenestration (OR, 19.62; P < 0.001). The low-lying aneurysms significantly necessitated the coagulation of the dura covering the anterior clinoid process (ACP) (OR, 7.43; P = 0.003) or anterior clinoidectomy (OR, 91.0; P < 0.001). We preferred straight clips in 45 (83%) of 54 posterolateral projecting aneurysms (OR, 45.0; P < 0.001), but preferred curved clips for posteromedial projecting aneurysms (OR, 6.39; P = 0.008). The mean operative time from the brain retraction to the final clipping was 17 minutes and 43 seconds. Postoperative computed tomography angiography revealed complete occlusion of 60 (94%) aneurysms. Three (4.6%) patients with acute SAH suffered postoperative lacunar infarction. For ruptured aneurysms, lamina terminalis and Liliequist membrane fenestration are useful for additional cerebrospinal fluid drainage. For low-lying aneurysms, coagulation of the dura covering the ACP or tailored anterior clinoidectomy might be necessary for exposing the proximal aneurysm neck. Type of clips depends on the direction of projection. The microsurgical clipping of the PCoAAs can achieve good immediate complete occlusion rate with low postoperative stroke rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Endovascular treatment of radiation-induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases

    International Nuclear Information System (INIS)

    Cheng, K.-M.; Chiu, H.-M.; Chan, C.-M.; Cheung, Y.-L.; Tang, K.-W.; Law, C.-K.

    2001-01-01

    Hemorrhage from rupture of petrous ICA aneurysm can be life threatening and emergency treatment is required. We report 2 cases of radiation-induced petrous internal carotid artery (ICA) aneurysm presenting with acute hemorrhage (epistaxis and otorrhagia) after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Both patients had a history of RT treatment for NPC. The first patient, a 54-year-old man, presented with sudden severe epistaxis and hemorrhagic shock. The second patient, a 35-year-old man, presented with episodes of severe otorrhagia. The first patient was immediately resuscitated. Obliteration of the aneurysm was performed by endovascular occlusion of the ICA with Guglielmi detachable coils and fibered platinum coils. For the second patient, the aneurysm was treated by deploying a self-expandable stent across the aneurysm neck. In an emergency situation, ruptured petrous ICA aneurysm can be treated with endovascular occlusion of the ICA with micro-coils if there is a good collateral blood flow. Alternatively, the aneurysm can be treated by deployment of a stent, which can induce stasis and eventual thrombosis of the aneurysm. (author)

  4. Clinical value of virtual three-dimensional instrument and cerebral aneurysm models in the interventional preoperative simulation

    International Nuclear Information System (INIS)

    Wei Xin; Xie Xiaodong; Wang Chaohua

    2007-01-01

    Objective: To establish virtual three-dimensional instrument and cerebral aneurysm models by using three-dimensional moulding software, and to explore the effect of the models in interventional preoperative simulation. Methods: The virtual individual models including cerebral arteries and aneurysms were established by using the three-dimensional moulding software of 3D Studio MAX R3 based on standard virtual cerebral aneurysm models and individual DSA image. The virtual catheter, guide wire, stent and coil were also established. The study of interventional preoperative simulation was run in personal computer, and included 3 clinical cases. Results: The simulation results of the working angle and the moulding angle of the head of catheter and guide wire in 3 cases were identical with that of operation results. The simulation results of the requirement of number and size of coil in 1 case of anterior communicating aneurysm and 1 case of posterior communicating aneurysm were identical with that of operation results. The simulation results of coil for aneurysmal shape in 1 case of giant internal carotid artery aneurysm were more than 2 three-dimensional coils with size of 3 mm x 3 cm from the operation results, and the position of the second coil in aneurysmal neck was adjusted according to the results of real-time simulation. The results of retrospective simulation of operation procedure indicated that the simulation methods for regular and small aneurysms could become a routine simulation means but more simulation experience was needed to build up for the giant aneurysms. Conclusions: The virtual three-dimensional instrument and cerebral aneurysm models established by the general software provided a new study method for neuro-interventional preoperative simulation, and it played an important guidance role in developing neuro-interventional operation. (authors)

  5. True aneurysms of the posterior communicating artery: a systematic review and meta-analysis of individual patient data.

    Science.gov (United States)

    He, Wenzhuan; Gandhi, Chirag D; Quinn, John; Karimi, Reza; Prestigiacomo, Charles J

    2011-01-01

    To review and analyze systematically the reported cases of "true" posterior communicating artery (PCoA) aneurysm. A retrospective review of the published literature was performed, and a meta-analysis of individual patient data was conducted. Pooled data showed that "true" PCoA aneurysms represent about 1.3% (95% confidence interval [CI] 0.8%, 1.7%) of all intracranial aneurysms and 6.8% (95% CI 4.3%, 9.2%) of all PCoA aneurysms. Mean patient age was 53.5 years (53.5 years ± 15.4), and age range was 23-79 years. Of the 49 patients reported in the literature, 44 (89.8%) were reported as ruptured, and 4 (10.2%) were reported as unruptured. There were no significant differences in ruptured status between age (P = 0.321), left vs right aneurysm (P = 0.537), and shape of aneurysm (P = 0.408). No significant differences in complication rates were found between rupture status (P = 0.27), and operative modalities (P = 0.878). The mean ages of patients who had no complications and patients who had complications were 53 years (53 years ± 2.59) vs 53.2 years (53.2 years ± 5.02) (P = 0.972). "True" PCoA aneurysms represent about 1.3% of all intracranial aneurysms and 6.8% of all PCoA aneurysms. They are more prone to rupture compared with their counterpart junctional aneurysms. When surgical management is indicated, a good understanding of the location and configuration of the aneurysm neck before surgical treatment is critical in the successful treatment of these lesions. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Selective embolization of unruptured intracranial aneurysms is associated with low retreatment rate

    Energy Technology Data Exchange (ETDEWEB)

    Bandeira, Alexandra; Raphaeli, Guy [Erasme University Hospital, Department of Radiology, Neuroradiology Section, Brussels (Belgium); Erasme University Hospital, Interventional Neuroradiology Fellows, Brussels (Belgium); Baleriaux, Danielle [Erasme University Hospital, Department of Radiology, Neuroradiology Section, Brussels (Belgium); Bruneau, Michael; Witte, Olivier De [Erasme University Hospital, Neurosurgery, Brussels (Belgium); Lubicz, Boris [Erasme University Hospital, Department of Radiology, Neuroradiology Section, Brussels (Belgium); Hopital Erasme, Service de Radiologie, Brussels (Belgium)

    2010-02-15

    To report long-term imaging findings of 101 patients with 129 unruptured intracranial aneurysms (UIA) treated by embolization. A retrospective review of our prospectively maintained database identified all patients with an UIA treated by embolization with coils only and with a minimal 12-month imaging follow-up. The clinical charts, procedural data, and angiographic results were reviewed. Between March 2004 and June 2009, 101 patients with 129 UIA were identified (71 women/30 men, mean age = 51.4 years). Ninety-four aneurysms (73%) were large (10-25 mm), and 35 (27%) were small (<10 mm). Aneurysms mean size was 10.7 mm (median, 9 mm; range 3-22 mm); 87 UIA (67.5%) had a small neck (<4 mm or neck/sac ratio < 0.7), and 42 (32.5%) had a wide neck ({>=}4 mm or neck/sac ratio {>=} 0.7). Selective coiling with bare/coated coils was performed in 125 cases and four cases, respectively. The balloon-assisted technique was used in 47 cases (36.4%). Only one patient experienced a symptomatic complication (thromboembolism) and kept a slight hemiparesis. Immediate results included 77 complete occlusions (59.7%), 45 neck remnants (34.9%), and 7 incomplete occlusions (5.4%). Mean imaging follow-up of 32 months showed 104 stable occlusions (80.6%), 12 further thrombosis (9.3%), 7 major recanalizations (5.4%), and 6 minor recanalizations (4.7%). Retreatment was required in seven wide-necked and/or large aneurysms including four treated with coated coils. No bleeding occurred during follow-up. Selective embolization of UIA is associated with stable long-term anatomical results and low retreatment rate. (orig.)

  7. Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms

    International Nuclear Information System (INIS)

    Lubicz, Boris; Bandeira, Alexandra; Baleriaux, Danielle; Bruneau, Michael; Witte, Olivier de; Dewindt, Aloys

    2009-01-01

    Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical findings in 32 patients with 34 wide-necked IA treated by SAC. A retrospective review of our prospectively maintained database identified all patients followed up for wide-necked IA treated by SAC. The clinical charts, procedural data, and angiographic results were reviewed. Thirty-two patients with 34 IA were identified including 25 asymptomatic patients, four with cranial nerve palsies, two with a subarachnoid hemorrhage, and one with transient ischemic attacks. Mean aneurysm size was 10.2 mm (range 3.5 to 26 mm). Embolization was successful in all patients and no procedure-related neurological morbidity or mortality was observed. Immediate anatomical results included nine complete occlusions (26.5%), two neck remnants (6%), and 23 incomplete occlusions (67.5%). Mean imaging follow-up of 20 months showed 18 further thrombosis (53%) and 16 stable results (47%). Finally, 27 aneurysms were completely occluded (79%), three had a neck remnant (9%), and four were incompletely occluded (12%). Asymptomatic and nonsignificant in-stent stenosis occurred in seven patients (22%). SAC is safe and effective for the treatment of wide-necked IA. Despite unsatisfying immediate aneurysm occlusion, the adjunctive effect of the stent is stabilizing or significantly improving long-term anatomical results. (orig.)

  8. Magnetic resonance angiography with ultrashort echo times reduces the artefact of aneurysm clips

    International Nuclear Information System (INIS)

    Goenner, F.; Heid, O.; Remonda, L.; Schroth, G.; Loevblad, K.O.; Guzman, R.; Barth, A.

    2002-01-01

    We evaluated the ability of an ultrashort echo time (TE) three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) sequence to reduce the metal artefact of intracranial aneurysm clips and to display adjacent cerebral arteries. In five patients (aged 8-72 years) treated with Elgiloy or Phynox aneurysm clips we prospectively performed a conventional (TE 6.0 ms) and a new ultrashort TE (TE 2.4 ms) 3D TOF MRA. We compared the diameter of the clip-induced susceptibility artefact and the detectability of flow in adjacent vessels. The mean artefact diameter was 22.3±6.4 mm (range 14-38 mm) with the ultrashort TE and 27.7±6.4 mm (range 19-45 mm) with the conventional MRA (P<0.0001). This corresponded to a diameter reduction of 19.5±9.2%. More parts of adjacent vessels were detected, but with less intense flow signal. The aneurysm dome and neck remained within the area of signal loss and were therefore not displayed. Ultrashort TE MRA is a noninvasive and fast method for improving detection of vessels adjacent to clipped intracranial aneurysms, by reducing clip-induced susceptibility artefact. The method cannot, however, be used to show remnants of the aneurysm neck or sac as a result of imperfect clipping. (orig.)

  9. Ruptured Aneurysms of the Occipital Artery Associated with Congenital Occipital Bone Defect.

    Science.gov (United States)

    Kawasaki, Toshinari; Yoshida, Kazumichi; Kikuchi, Takayuki; Ishii, Akira; Takagi, Yasushi; Miyamoto, Susumu

    2017-01-01

    Traumatic aneurysms of the superficial temporal artery have been frequently reported in the literature, whereas traumatic aneurysms of the occipital artery (OA) are extremely rare. A 30-year-old man had been followed at another hospital for meningoencephalocele associated with his congenital occipital bone defect. He was admitted to our hospital with a chief complaint of neck swelling and pain during a football game. Computed tomography and magnetic resonance imaging showed a hematoma in his right neck along with the meningoencephalocele. In addition, it showed an atrophic cerebellum with a cyst protruding from his occipital bone defect. Digital subtraction angiography of the right OA showed 3 aneurysms responsible for the large hematoma in his neck. Endovascular embolization with 20% N-butyl-2-cyanoacrylate was performed for treatment of the ruptured aneurysms followed by emergent surgical evacuation of the hematoma. An occipital cranioplasty with titanium mesh was performed 10 months after the emergent intervention. In this patient, the congenital occipital bone defect with meningoencephalocele might have been the remote source of risk for traumatic pseudoaneurysms along the muscle branches of the OA. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Intravoxel incoehrent motion MR imaging in the head and neck: Correlation with dynamic contrast-enhanced MR imaging and diffusion-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Xiao Quan; Choi, Young Jun; Sung, Yu Sub; Jang, Seung Won; Park, Ji Eun; Heo, Young Jin; Beak, Jung Hwan; Lee, Jeong Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Yoon, Ra Gyoung [Dept. of Radiology, Catholic Kwandong University International St. Mary' s Hospital, Catholic Kwandong University College of Medicine, Incheon (Korea, Republic of)

    2016-09-15

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D{sup *}), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D{sup *} and model-free parameters from the DCE-MRI (wash-in, T{sub max}, E{sub max}, initial AUC{sub 60}, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D{sup *} and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D{sup *} (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

  11. Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Xiao Quan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029 (China); Choi, Young Jun; Sung, Yu Sub [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Yoon, Ra Gyoung [Department of Radiology, Catholic Kwandong University International St. Mary' s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711 (Korea, Republic of); Jang, Seung Won; Park, Ji Eun [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Heo, Young Jin [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392 (Korea, Republic of); Baek, Jung Hwan; Lee, Jeong Hyun [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of)

    2016-11-01

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D{sup *}), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D{sup *} and model-free parameters from the DCE-MRI (wash-in, T{sub max}, E{sub max}, initial AUC{sub 60}, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D{sup *} and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D{sup *} (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

  12. Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging.

    Science.gov (United States)

    Xu, Xiao Quan; Choi, Young Jun; Sung, Yu Sub; Yoon, Ra Gyoung; Jang, Seung Won; Park, Ji Eun; Heo, Young Jin; Baek, Jung Hwan; Lee, Jeong Hyun

    2016-01-01

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D(*)), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D(*) and model-free parameters from the DCE-MRI (wash-in, Tmax, Emax, initial AUC60, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D(*) and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D(*) (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

  13. Intravoxel incoehrent motion MR imaging in the head and neck: Correlation with dynamic contrast-enhanced MR imaging and diffusion-weighted imaging

    International Nuclear Information System (INIS)

    Xu, Xiao Quan; Choi, Young Jun; Sung, Yu Sub; Jang, Seung Won; Park, Ji Eun; Heo, Young Jin; Beak, Jung Hwan; Lee, Jeong Hyun; Yoon, Ra Gyoung

    2016-01-01

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D * ), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D * and model-free parameters from the DCE-MRI (wash-in, T max , E max , initial AUC 60 , whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D * and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D * (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck

  14. Variability of computational fluid dynamics solutions for pressure and flow in a giant aneurysm: the ASME 2012 Summer Bioengineering Conference CFD Challenge.

    Science.gov (United States)

    Steinman, David A; Hoi, Yiemeng; Fahy, Paul; Morris, Liam; Walsh, Michael T; Aristokleous, Nicolas; Anayiotos, Andreas S; Papaharilaou, Yannis; Arzani, Amirhossein; Shadden, Shawn C; Berg, Philipp; Janiga, Gábor; Bols, Joris; Segers, Patrick; Bressloff, Neil W; Cibis, Merih; Gijsen, Frank H; Cito, Salvatore; Pallarés, Jordi; Browne, Leonard D; Costelloe, Jennifer A; Lynch, Adrian G; Degroote, Joris; Vierendeels, Jan; Fu, Wenyu; Qiao, Aike; Hodis, Simona; Kallmes, David F; Kalsi, Hardeep; Long, Quan; Kheyfets, Vitaly O; Finol, Ender A; Kono, Kenichi; Malek, Adel M; Lauric, Alexandra; Menon, Prahlad G; Pekkan, Kerem; Esmaily Moghadam, Mahdi; Marsden, Alison L; Oshima, Marie; Katagiri, Kengo; Peiffer, Véronique; Mohamied, Yumnah; Sherwin, Spencer J; Schaller, Jens; Goubergrits, Leonid; Usera, Gabriel; Mendina, Mariana; Valen-Sendstad, Kristian; Habets, Damiaan F; Xiang, Jianping; Meng, Hui; Yu, Yue; Karniadakis, George E; Shaffer, Nicholas; Loth, Francis

    2013-02-01

    Stimulated by a recent controversy regarding pressure drops predicted in a giant aneurysm with a proximal stenosis, the present study sought to assess variability in the prediction of pressures and flow by a wide variety of research groups. In phase I, lumen geometry, flow rates, and fluid properties were specified, leaving each research group to choose their solver, discretization, and solution strategies. Variability was assessed by having each group interpolate their results onto a standardized mesh and centerline. For phase II, a physical model of the geometry was constructed, from which pressure and flow rates were measured. Groups repeated their simulations using a geometry reconstructed from a micro-computed tomography (CT) scan of the physical model with the measured flow rates and fluid properties. Phase I results from 25 groups demonstrated remarkable consistency in the pressure patterns, with the majority predicting peak systolic pressure drops within 8% of each other. Aneurysm sac flow patterns were more variable with only a few groups reporting peak systolic flow instabilities owing to their use of high temporal resolutions. Variability for phase II was comparable, and the median predicted pressure drops were within a few millimeters of mercury of the measured values but only after accounting for submillimeter errors in the reconstruction of the life-sized flow model from micro-CT. In summary, pressure can be predicted with consistency by CFD across a wide range of solvers and solution strategies, but this may not hold true for specific flow patterns or derived quantities. Future challenges are needed and should focus on hemodynamic quantities thought to be of clinical interest.

  15. Hemodynamic transition driven by stent porosity in sidewall aneurysms.

    Science.gov (United States)

    Bouillot, Pierre; Brina, Olivier; Ouared, Rafik; Lovblad, Karl-Olof; Farhat, Mohamed; Pereira, Vitor Mendes

    2015-05-01

    The healing process of intracranial aneurysms (IAs) treated with flow diverter stents (FDSs) depends on the IA flow modifications and on the epithelization process over the neck. In sidewall IA models with straight parent artery, two main hemodynamic regimes with different flow patterns and IA flow magnitude were broadly observed for unstented and high porosity stented IA on one side, and low porosity stented IA on the other side. The hemodynamic transition between these two regimes is potentially involved in thrombosis formation. In the present study, CFD simulations and multi-time lag (MTL) particle imaging velocimetry (PIV) measurements were combined to investigate the physical nature of this transition. Measurable velocity fields and non-measurable shear stress and pressure fields were assessed experimentally and numerically in the aneurysm volume in the presence of stents with various porosities. The two main regimes observed in both PIV and CFD showed typical flow features of shear and pressure driven regimes. In particular, the waveform of the averaged IA velocities was matching both the shear stress waveform at IA neck or the pressure gradient waveform in parent artery. Moreover, the transition between the two regimes was controlled by stent porosity: a decrease of stent porosity leads to an increase (decrease) of pressure differential (shear stress) through IA neck. Finally, a good PIV-CFD agreement was found except in transitional regimes and low motion eddies due to small mismatch of PIV-CFD running conditions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Giant serpentine intracranial aneurysm: a case report

    International Nuclear Information System (INIS)

    Park, Jae Seong; Lee, Myeong Sub; Kim, Myung Soon; Kim, Dong Jin; Park, Joong Wha; Whang, Kum

    2001-01-01

    The authors present a case of giant serpentine aneurysm (a partially thrombosed aneurysm containing tortuous vascular channels with a separate entrance and outflow pathway). Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms, distinct from saccular and fusiform varieties, and in this case, too, the clinical presentation and radiographic features of CT, MR imaging and angiography were distinct

  17. Cerebral aneurysms – an audit

    African Journals Online (AJOL)

    Enrique

    Abstract. We performed an audit to determine the profile of cerebral aneurysms at the Universitas Hospital Bloem- fontein, the only government hospital with a vascular suite in the Free State and Northern Cape area. Two hun- dred and twenty-three government patients, diagnosed with cerebral aneurysms during the period.

  18. A case of Behcet's disease with aneurysms of common carotid arteries and abdominal aorta

    International Nuclear Information System (INIS)

    Choo, Yeon Myung; Chang, Kee Hyun; Choi, Sung Jae

    1984-01-01

    One case of Behcet's disease with multiple aneurysms in both common carotid arteries and abdominal aorta is presented with brief review of the literatures. A 26-year-old woman had slowly enlarging pulsatile masses in both sides of neck and recurrent ulcerations in oral cavity and genitalia. One day prior to admission, aphasia, right facial nerve palsy and right hemiplegia suddenly developed. Brain CT showed acute infarction in left basal ganglia. Both Carotid Angiography and abdominal Aortography demonstrated multiple aneurysms in both common carotid arteries and abdominal aorta with organizing thrombi and thromboembolism of internal carotid artery

  19. Mycotic aneurysms in intravenous drug abusers: the utility of intravenous digital subtraction angiography

    International Nuclear Information System (INIS)

    Shetty, P.C.; Krasicky, G.A.; Sharma, R.P.; Vemuri, B.R.; Burke, M.M.

    1985-01-01

    Two-hundred thirteen intravenous digital subtraction angiographic (DSA) examinations were performed on 195 intravenous drug abusers to rule out the possibility of a mycotic aneurysm in a groin, neck, or upper extremity infection. Twenty-three surgically proved cases of mycotic aneurysm were correctly identified with no false positive results. In addition, six cases of major venous occlusion were documented. The authors present the results of their experience and conclude that DSA is an effective and cost-efficient method of examining this high risk patient population

  20. Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent

    DEFF Research Database (Denmark)

    Wagner, Aase; Cortsen, Marie; Hauerberg, John

    2011-01-01

    the periprocedural complications, immediate result, late complications, imaging follow-up at 6 and 12 months and clinical follow-up at 2-23 months. METHODS: Twenty-two patients with 26 wide-necked or blister-like aneurysms had 23 treatments with implantation of a Silk stent. Eleven patients had re...... (86%) were occluded. CONCLUSION: The effect of the Silk FD in terms of occlusion of the aneurysms seems to occur mainly during the first 6 months after placement but continues during the following time. Most delayed complications occur immediately after discontinuing the anticoagulation medication...

  1. First Indian single center experience with pipeline embolization device for complex intracranial aneurysms.

    Science.gov (United States)

    Cherian, Mathew P; Yadav, Manish Kumar; Mehta, Pankaj; Vijayan, K; Arulselvan, V; Jayabalan, Suresh

    2014-01-01

    Flow diversion is a novel method of therapy wherein an endoluminal sleeve, the flow diverter stent is placed across the neck of complex aneurysms to curatively reconstruct abnormal vasculature. We present the first Indian single center experience with the pipeline embolization device (PED) and 6 months follow-up results of 5 patients. Five complex or recurrent intracranial aneurysms in five patients were treated with PED. The patients were followed-up with magnetic resonance angiography (MRA) after 4 weeks and conventional angiography after 6 months. Feasibility, complications, clinical outcome, early 1-month MRA and 6 months conventional angiographic follow-up results were analyzed. Of the five aneurysms treated, four were in the anterior circulation and one in the posterior circulation. All five patients were treated with a single PED in each, and additionally coils were used in one patient. At 1-month MRA follow-up, complete occlusion was seen in 2 (40%) of the five cases. Post 6 months conventional angiography showed complete occlusion of the aneurysm sac in all five cases (100%). Side branch ostia were covered in three patients, all of which were patent (100%). There was no incidence of major neurological morbidity or mortality. One patient (20%) who had basilar top aneurysm experienced minor neurological disability after 5 days which partially improved. Pipeline embolization device for complex and recurrent aneurysms is technically feasible, safe, offers low complication rate, and definitive vascular reconstruction. PED can be used without fear of occlusion of covered eloquent side branches and perforators.

  2. Median Supraorbital Keyhole Approach for Clipping Ruptured Distal Anterior Cerebral Artery Aneurysm: Technical Report with Review of Literature.

    Science.gov (United States)

    Dhandapani, Sivashanmugam; Sahoo, Sushant Kumar

    2018-04-01

    The minimally invasive approach to distal anterior cerebral artery (DACA) aneurysms has not gained much acceptance due to difficulties associated with the conventional frontal paramedian approach. The more proximal basal interhemispheric approach, however, necessitates extensive dissection of soft tissues. We describe a novel minimally invasive median supraorbital keyhole craniotomy with a basal interhemispheric approach for clipping a ruptured DACA aneurysm. A 62-year-old patient presented with subarachnoid hemorrhage. Computed tomography angiography revealed a DACA aneurysm. The surgical technique involved a keyhole craniotomy made via an eyebrow incision extending between the supraorbital notches, and flush with the anterior cranial fossa. The dura was opened at the anterior part, the falx was cut, an interhemispheric dissection was carried out, adequate proximal control was obtained, and the aneurysm neck was dissected and clipped. A relevant review of the literature was carried out. The patient recovered well, with no residual aneurysm or forehead numbness, with good cosmesis. Compared with the previously described "keyhole unilateral interhemispheric" approaches, our technique has less likelihood of encountering bridging veins; easier cisternal cerebrospinal fluid release, making it feasible even in swollen brain; better proximal vascular control; and trajectory toward the neck rather than dome. The median supraorbital keyhole approach is a minimally invasive technique sufficient for clipping most DACA aneurysms, with easier access, better proximal control, and good cosmesis. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Preliminary evaluation of 3D TOF MRA fly-around advantages in the diagnosis of internal carotid artery aneurysms

    International Nuclear Information System (INIS)

    Zhu Yusen; Zhang Lina; Xu Ke; Li Songbai; Huang Yanling; Sun Wenge; Jin Anyu; Qi Xixun; Li Yanliang

    2004-01-01

    Objective: To assess the advantages and the clinical application value of 3D TOF MR angiography fly-around in diagnosing internal carotid artery aneurysms in comparison with multi-slice helical CT three dimensional angiography (MS 3D-CTA) and digital subtraction angiography (DSA). Methods: Eighteen patients with clinical suspected internal carotid artery aneurysms were involved in the study. There were 4 males and 14 females, and their age ranged from 17 to 76 years. 14 patients were with subarachnoid hemorrhage and 4 patients with oculomotor nerve palsy. All these patients underwent 3D TOF MRA and MS 3D-CTA, and 17 patients underwent DSA. All of them accepted operation treatment. 3D TOF MRA was performed with Toshiba 1.5 T MRI system and the parameters of 3D-TOF sequence were: TR 30 ms, TE 6.8 ms, field of view 17 cm x 19 cm, matrix 160 x 256, slab thickness 50-60 mm, section thickness 1.2 mm, flip angle 20 degree. Row data of MS 3D-CTA was acquired by Multi-slice helical CT-Aquilion (Toshiba). The scanning parameters were: image slice thickness 1.0 mm, scan speed 0.5 s/r, helical pitch 3.5, delay time 15-18 sec. Nonionic contrast agent was injected intravenously (2.0 ml/kg) at the speed of 4.0-5.0 ml/s using a power injector. Source images of 3D TOF MRA and MS 3D-CTA were processed into MIP and fly-around using a workstation SGI-O2, with the post-processing software Alatoview (Ver: 1.42). Conventional four-vessel digital subtraction angiography was performed with Siemens Multi-Start OT. Results: 22 aneurysms were detected by both 3D TOF MRA and MS 3D-CTA (1 ACA aneurysm, 3 ACoMA aneurysms, 1 left MCA aneurysm, 2 ICA-cavernous aneurysms, 3 left ICA-PCoM aneurysms, 8 right ICA-PCoM aneurysms, 1 left ICA-AChA aneurysms, 2 right ICA-AChA aneurysms, and 1 superior pituitary artery aneurysm). Among those aneurysms, one was not detected by DSA, and another aneurysm's neck was not clear on the image of DSA. 1 right ICA-PCoM aneurysm was surgically treated according to 3D

  4. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    International Nuclear Information System (INIS)

    Briganti, Francesco; Napoli, Manuela; Leone, Giuseppe; Marseglia, Mariano; Mariniello, Giuseppe; Caranci, Ferdinando; Tortora, Fabio; Maiuri, Francesco

    2014-01-01

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  5. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, Francesco, E-mail: frabriga@unina.it [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: napoli.manuela@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: g.leonemd@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: mariano-marseglia@libero.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: giuseppe.mariniello@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: ferdinando.caranci@unina.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: fabiotor@libero.it [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: frmaiuri@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)

    2014-09-15

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  6. Intercomparison of two dynamic treatment techniques, ring scan and spot scan, for head and neck tumors with the Piotron

    International Nuclear Information System (INIS)

    Takai, M.; Blattmann, H.; Pedroni, E.

    1988-01-01

    An evaluation of the ring scan and the spot scan was made for the pion irradiation of head and neck tumors with the Piotron. For the geometry of the Piotron, with its 60 radially converging beams, two scanning techniques have been developed, ring scan and spot scan. They have different characteristics concerning achievable dose distributions and sensitivity to tissue inhomogenities. The optimized 3-dimensional dose distributions for the treatment with ring scan and spot scan techniques were calculated for two examples of the target volume. The comparison of the dose distributions has shown that the ring scan is better in sparing normal tissues than the spot scan for a simple shape target volume but not for an irregular shape target volume with the present status of the technique. The irradiation time needed for the ring scan is longer, for the present examples three times, than for the spot scan. From the practical view point the spot scan is preferable to the ring scan for the treatment of head and neck tumors with the Piotron

  7. Parsing the roles of neck-linker docking and tethered head diffusion in the stepping dynamics of kinesin.

    Science.gov (United States)

    Zhang, Zhechun; Goldtzvik, Yonathan; Thirumalai, D

    2017-11-14

    Kinesin walks processively on microtubules (MTs) in an asymmetric hand-over-hand manner consuming one ATP molecule per 16-nm step. The individual contributions due to docking of the approximately 13-residue neck linker to the leading head (deemed to be the power stroke) and diffusion of the trailing head (TH) that contributes in propelling the motor by 16 nm have not been quantified. We use molecular simulations by creating a coarse-grained model of the MT-kinesin complex, which reproduces the measured stall force as well as the force required to dislodge the motor head from the MT, to show that nearly three-quarters of the step occurs by bidirectional stochastic motion of the TH. However, docking of the neck linker to the leading head constrains the extent of diffusion and minimizes the probability that kinesin takes side steps, implying that both the events are necessary in the motility of kinesin and for the maintenance of processivity. Surprisingly, we find that during a single step, the TH stochastically hops multiple times between the geometrically accessible neighboring sites on the MT before forming a stable interaction with the target binding site with correct orientation between the motor head and the [Formula: see text] tubulin dimer.

  8. Detection of Local Tumor Recurrence After Definitive Treatment of Head and Neck Squamous Cell Carcinoma: Histogram Analysis of Dynamic Contrast-Enhanced T1-Weighted Perfusion MRI.

    Science.gov (United States)

    Choi, Sang Hyun; Lee, Jeong Hyun; Choi, Young Jun; Park, Ji Eun; Sung, Yu Sub; Kim, Namkug; Baek, Jung Hwan

    2017-01-01

    This study aimed to explore the added value of histogram analysis of the ratio of initial to final 90-second time-signal intensity AUC (AUCR) for differentiating local tumor recurrence from contrast-enhancing scar on follow-up dynamic contrast-enhanced T1-weighted perfusion MRI of patients treated for head and neck squamous cell carcinoma (HNSCC). AUCR histogram parameters were assessed among tumor recurrence (n = 19) and contrast-enhancing scar (n = 27) at primary sites and compared using the t test. ROC analysis was used to determine the best differentiating parameters. The added value of AUCR histogram parameters was assessed when they were added to inconclusive conventional MRI results. Histogram analysis showed statistically significant differences in the 50th, 75th, and 90th percentiles of the AUCR values between the two groups (p Histogram analysis of AUCR can improve the diagnostic yield for local tumor recurrence during surveillance after treatment for HNSCC.

  9. A new flow-diverter(the FloWise): In vivo evaluation in an elastase-induced rabbit aneurysm model

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byung Moon; Kim, Dong Joon; Kim, Dong Ik [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-02-15

    We aimed to evaluate the efficacy and safety of a newly developed, partially retrievable flow-diverter (the FloWise) in an elastase-induced rabbit aneurysm model. We developed a partially retrievable flow diverter composed of 48 strands of Nitinol and platinum wire. The FloWise is compatible with any microcatheter of 0.027-inch inner diameter, and is retrievable up to 70% deployment. The efficacy and safety of the FloWise were evaluated in the elastase-induced rabbit aneurysm model. The rate of technical success (full coverage of aneurysm neck) and assessment of aneurysm occlusion and stent patency was conducted by angiograms and histologic examinations at the 1-month, 3-month, and 6-month follow-up. The patency of small arterial branches (intercostal or lumbar arteries) covered by the FloWise were also assessed in the 5 subjects. We attempted FloWise insertion in a total of 32 aneurysm models. FloWise placement was successful in 31 subjects (96.9%). Two stents (6.2%) were occluded at the 3-month follow-up, but there was no evidence of in-stent stenosis in other subjects. All stented aneurysms showed progressive occlusion: grade I (complete aneurysm occlusion) in 44.4% and grade II (aneurysm occlusion > 90%) in 55.6% at 1 month; grade I in 90% and II in 10% at 3 months; and grade I in 90% and II in 10% at 6 months. All small arterial branches covered by the FloWise remained patent. A newly developed, partially retrievable flow-diverter seems to be a safe and effective tool of aneurysm occlusion, as evaluated in the rabbit aneurysm model.

  10. Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series

    International Nuclear Information System (INIS)

    Mejdoubi, Mehdi; Cognard, Christophe; Gigaud, Michel; Tremoulet, Michel; Albucher, Jean-Francois

    2006-01-01

    From January 1998 to December 2002, endovascular treatment (EVT) was used as first intention in all patients with ruptured aneurysms. The objective of this study was to analyze the results of this therapeutic strategy. Among 401 patients admitted with a subarachnoid hemorrhage (SAH), 73 (18%) had a nonaneurysmal perimesencephalic SAH, 28 were not explored by angiography due to very poor clinical status, and 28 with aneurysmal SAH were not treated due to poor clinical status. Thus, of the 300 patients with a proven aneurysmal SAH, 272 (83%) were treated. EVT was attempted in 230 patients and was successful in 222 (82%), and clipping was performed in 50 (18%). Finally, EVT was successful in 234 aneurysms (96.7%) in 222 patients out of 242 aneurysms in 230 patients (some of the patients were treated for more than one aneurysm in the same procedure). EVT-related morbidity occurred in ten patients (4.5%) and mortality in eight (3.6%). Rate of dependency or death (modified Rankin scale 3-5) was 24.5% at 26 months. Initially, complete aneurysm occlusion was obtained in 81%, a dog ear in 3.4%, a neck remnant in 8% and incomplete occlusion in 8.1% of the patients. At follow-up (mean 26 months), the occlusion rate remained stable at 75%. This consecutive prospective series shows that EVT can be performed routinely as first-intention treatment in most aneurysmal SAH. Using this therapeutic strategy, EVT was performed in 82% of patients with long-term clinical results similar to those of the ISAT study. (orig.)

  11. Right hepatic artery aneurysm.

    Science.gov (United States)

    Bernal, Astrid Del Pilar Ardila; Loures, Paulo; Calle, Juan Cristóbal Ospina; Cunha, Beatriz; Córdoba, Juan Camilo

    2016-01-01

    We report a case of an aneurysm of the right hepatic artery and its multidisciplinary management by general surgery, endoscopy and radiology services. Being a case of extremely low incidence, it is important to show its diagnostic and therapeutic approach. RESUMO Relatamos um caso de aneurisma da artéria hepática direita conduzido de forma multidisciplinar pelos Serviços de Cirurgia Geral, Endoscopia e Radiologia. Em se tratando de caso de incidência baixíssima, é importante mostrar o enfoque diagnóstico e terapêutico usado em seu manejo.

  12. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series

    DEFF Research Database (Denmark)

    Pierot, Laurent; Moret, Jacques; Barreau, Xavier

    2018-01-01

    BACKGROUND: Flow disruption with the WEB is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown a low complication rate with good efficacy. PURPOSE: To report clinical and anatomical results of the WEB treatment in the cumulative popula...

  13. Primary extracranial vertebral artery aneurysms.

    Science.gov (United States)

    Morasch, Mark D; Phade, Sachin V; Naughton, Peter; Garcia-Toca, Manuel; Escobar, Guillermo; Berguer, Ramon

    2013-05-01

    Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult. Accessing aneurysms at the skull base can be difficult and, because the frail arteries are often afflicted with connective tissue abnormalities, direct repair can be particularly challenging. We describe the presentation and surgical management of patients with primary extracranial vertebral artery aneurysms. In this study we performed a retrospective, multi-institutional review of patients with primary aneurysms within the extracranial vertebral artery. Between January 2000 and January 2011, 7 patients, aged 12-56 years, were noted to have 9 primary extracranial vertebral artery aneurysms. All had underlying connective tissue or another hereditary disorder, including Ehler-Danlos syndrome (n=3), Marfan's disease (n=2), neurofibromatosis (n=1), and an unspecified connective tissue abnormality (n=1). Eight of 9 aneurysms were managed operatively, including an attempted bypass that ultimately required vertebral ligation; the contralateral aneurysm on this patient has not been treated. Open interventions included vertebral bypass with vein, external carotid autograft, and vertebral transposition to the internal carotid artery. Special techniques were used for handling the anastomoses in patients with Ehler-Danlos syndrome. Although endovascular exclusion was not performed in isolation, 2 hybrid procedures were performed. There were no instances of perioperative stroke or death. Primary extracranial vertebral artery aneurysms are rare and occur in patients with hereditary disorders. Operative intervention is warranted in symptomatic patients. Exclusion and reconstruction may be performed with open and hybrid techniques with low morbidity and mortality. Copyright © 2013 Elsevier Inc. All rights

  14. HydroSoft coil versus HydroCoil for endovascular aneurysm occlusion study: A single center experience

    International Nuclear Information System (INIS)

    Guo Xinbin; Fan Yimu; Zhang Jianning

    2011-01-01

    Background and purpose: The HydroCoil Embolic System (HES) was developed to reduce recurrences of aneurysms relative to platinum coils. But the HydroCoil Embolic System was characterized with many limitations. The manufacturer had recognized the challenge and recently a new design of hydrogel-coated coil-HydroSoft has become available in the market as the new generation HydroCoil. We reported our initial experience using HydroSoft coil versus HydroCoil in our center. Methods: 75 aneurysms embolized primarily using HydroSoft Coils from July 2008 to May 2009 were compared with 66 volume- and shape-matched aneurysms treated with HydroCoils from March 2006 to August 2008. Outcome measures included length and number of coils used, contrast volume, and length of hospital stay. During embolization, a stable framework was first established with bare coils, and hydrogel-coated coils were used subsequently to increase the packing density. Follow-up angiographic results 6 months after treatment were evaluated among some of the patients. Results: Successful coil embolization was achieved in all patients. There were no differences in average total coil length used per aneurysm. There were no differences in length of hospital stay and packing density. HydroSoft coils were more suitable using as the finishing or final coil. HydroSoft coil decreased the procedure-related retreated rates, and aneurysm packing was finished with soft, flexible HydroSoft coil and decreased the neck remnant rates. Follow-up angiography in HydroSoft-treated patients at 6 months revealed aneurysm stability without significant residual neck. Conclusions: HydroSoft coil allowed us to deploy coated coils with good packing density. A slight expansion of these coils at the neck can be expected to reduce neck remnant and potentially inhibit recurrence.

  15. MR angiography of cerebral aneurysms

    International Nuclear Information System (INIS)

    Miki, Hitoshi; Tanada, Shuji; Sakaki, Saburo; Hamamoto, Ken; Sadamoto, Kazuhiko.

    1992-01-01

    Time-of-flight (TOF) MR angiography (MRA) and phase-contrast (PC) MRA are examined clinically for evaluating cerebral aneurysms. In the morphological diagnosis of cerebral aneurysms, three-dimensional (3D) MRA is superior to two-dimensional (2D) MRA because 3D MRA has a higher S/N ratio and a higher spatial resolution. However, it is difficult to decide which, 3D TOF MRA or 3D PC MRA, is superior, for both methods have many scan parameters. In our study, 3D PC MRA was performed using two methods; one had the same acquisition time as 3D TOF MRA, while the other had the same spatial resolution as 3D TOF MRA. The detectability of aneurysms by each MRA method was evaluated in comparison with 3D TOF MRA. In fifteen patients (6 males and 9 females), a total of 16 cerebral aneurysms (3 ruptured and 13 unruptured) were studied. The lesion sizes ranged from 2.5 to 18 mm. All the 16 lesions were examined by means of 3D TOF MRA, 3D PC MRA, and conventional angiography. MR imaging was performed with a 1.5 tesla MRI system (Signa). All of the 16 cerebral aneurysms were detected by 3D TOF MRA, while only 11 of them were detected by 3D PC MRA. When 3D PC MRA was performed with the same acquisition time as 3D TOF MRA, 3D PC MRA was superior in showing one of the 7 aneurysms. When 3D PC MRA was performed with same spatial resolution as 3D TOF MRA, 3D PC MRA was superior in showing two of the 10 aneurysms. 3D TOF MRA was superior to 3D PC MRA in the detection of cerebral aneurysms because of the long acquisition times and the different flow velocity, which induced different signal intensities between the aneurysms and parent arteries in 3D PC MRA. 3D PC MRA was superior to 3D TOF MRA in patients with large thrombotic aneurysms of the internal carotid artery. We consider that 3D TOF MRA should be the first choice for screening and following-up cerebral aneurysms. 3D PC MRA should then be performed for large cerebral aneurysms in addition to 3D TOF MRA. (author)

  16. Inflow hemodynamics evaluated by using four-dimensional flow magnetic resonance imaging and the size ratio of unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    Futami, Kazuya; Nambu, Iku; Kitabayashi, Tomohiro; Sano, Hiroki; Misaki, Kouichi; Uchiyama, Naoyuki; Nakada, Mitsutoshi

    2017-01-01

    Prediction of the rupture risk is critical for the identification of unruptured cerebral aneurysms (UCAs) eligible for invasive treatments. The size ratio (SR) is a strong morphological predictor for rupture. We investigated the relationship between the inflow hemodynamics evaluated on four-dimensional (4D) flow magnetic resonance (MR) imaging and the SR to identify specific characteristics related to UCA rupture. We evaluated the inflow jet patterns and inflow hemodynamic parameters of 70 UCAs on 4D flow MR imaging and compared them among 23 aneurysms with an SR ≥2.1 and 47 aneurysms with an SR ≤2.0. Based on the shape of inflow streamline bundles with a velocity ≥75% of the maximum flow velocity in the parent artery, the inflow jet patterns were classified as concentrated (C), diffuse (D), neck-limited (N), and unvisualized (U). The incidence of patterns C and N was significantly higher in aneurysms with an SR ≥2.1. The rate of pattern U was significantly higher in aneurysms with an SR ≤2.0. The maximum inflow rate and the inflow rate ratio were significantly higher in aneurysms with an SR ≥2.1. The SR affected the inflow jet pattern, the maximum inflow rate, and the inflow rate ratio of UCAs. In conjunction with the SR, inflow hemodynamic analysis using 4D flow MR imaging may contribute to the risk stratification for aneurysmal rupture. (orig.)

  17. Inflow hemodynamics evaluated by using four-dimensional flow magnetic resonance imaging and the size ratio of unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Futami, Kazuya [Matto-Ishikawa Central Hospital, Department of Neurosurgery, Hakusan, Ishikawa (Japan); Nambu, Iku; Kitabayashi, Tomohiro; Sano, Hiroki; Misaki, Kouichi; Uchiyama, Naoyuki; Nakada, Mitsutoshi [Kanazawa University School of Medicine, Department of Neurosurgery, Kanazawa, Ishikawa (Japan)

    2017-04-15

    Prediction of the rupture risk is critical for the identification of unruptured cerebral aneurysms (UCAs) eligible for invasive treatments. The size ratio (SR) is a strong morphological predictor for rupture. We investigated the relationship between the inflow hemodynamics evaluated on four-dimensional (4D) flow magnetic resonance (MR) imaging and the SR to identify specific characteristics related to UCA rupture. We evaluated the inflow jet patterns and inflow hemodynamic parameters of 70 UCAs on 4D flow MR imaging and compared them among 23 aneurysms with an SR ≥2.1 and 47 aneurysms with an SR ≤2.0. Based on the shape of inflow streamline bundles with a velocity ≥75% of the maximum flow velocity in the parent artery, the inflow jet patterns were classified as concentrated (C), diffuse (D), neck-limited (N), and unvisualized (U). The incidence of patterns C and N was significantly higher in aneurysms with an SR ≥2.1. The rate of pattern U was significantly higher in aneurysms with an SR ≤2.0. The maximum inflow rate and the inflow rate ratio were significantly higher in aneurysms with an SR ≥2.1. The SR affected the inflow jet pattern, the maximum inflow rate, and the inflow rate ratio of UCAs. In conjunction with the SR, inflow hemodynamic analysis using 4D flow MR imaging may contribute to the risk stratification for aneurysmal rupture. (orig.)

  18. Detection of intracranial aneurysms using multi-detector row CT 3D-angiography: comparison with operative findings

    Energy Technology Data Exchange (ETDEWEB)

    Han, You Mie; Lim, Soo Mee; Seo, Eui Kyo; Kim, Yoo Kyung [Mokdong Hospital, Ewha Womans University, Seoul (Korea, Republic of)

    2006-04-15

    To assess the efficacy of three-dimensional CT angiography (3D-CTA) using multi-detector row computed tomography (MDCT) in the evaluation of intracranial aneurysms in patients with non-traumatic acute subarachnoid hemorrhage and to describe those aneurysms which were not found 3D-CTA. 3D-CTA was done in 40 patients with non-traumatic subarachnoid hemorrhage by using a 16-slice MDCT; conventional digital subtraction angiography (DSA) was done in 36 of those patients within 12 hours. The CT and DSA images were reviewed by two radiologists and the site, size and neck of the aneurysms were evaluated. The results from these two modalities were then compared with the operative findings. We calculated the detection rates by 3D-CTA and DSA and evaluated the size differences of aneurysms diagnosed with 3D-DTA and those found at surgery. We also analyzed the locations and sizes of aneurysms missed by 3D-CTA and attempted to explain these false negatives. A total of 55 aneurysms were surgically confirmed in 40 patients. 48 of these were detected pre-operatively by 3D-CTA. Thus, the detection rate by 3D-CTA was 87%. The size difference of aneurysms as calculated by 3-D CTA and found operatively was as follows: less than 1 mm in 17 cases, within 1-2 mm in 15 cases, and more than 2 mm in 16 cases. Seven aneurysms were not detected by 3D-CTA. The major cause of these missed aneurysms was their small size. The undetected aneurysms were less than 2 mm in size, except for 2 instances of PCoA aneurysms. One case was not detected due to difficult image evaluation. A possible explanation of the one remaining missed aneurysms was the filling of the aneurismal sac by thrombosis. Though there were some limitations in the detection of aneurysms, 3D-CTA using 16-channel MDCT may provide sufficient pre-operative information for the management of patients with intracranial aneurysms in cases of emergency operations or DSA-failure.

  19. Detection of intracranial aneurysms using multi-detector row CT 3D-angiography: comparison with operative findings

    International Nuclear Information System (INIS)

    Han, You Mie; Lim, Soo Mee; Seo, Eui Kyo; Kim, Yoo Kyung

    2006-01-01

    To assess the efficacy of three-dimensional CT angiography (3D-CTA) using multi-detector row computed tomography (MDCT) in the evaluation of intracranial aneurysms in patients with non-traumatic acute subarachnoid hemorrhage and to describe those aneurysms which were not found 3D-CTA. 3D-CTA was done in 40 patients with non-traumatic subarachnoid hemorrhage by using a 16-slice MDCT; conventional digital subtraction angiography (DSA) was done in 36 of those patients within 12 hours. The CT and DSA images were reviewed by two radiologists and the site, size and neck of the aneurysms were evaluated. The results from these two modalities were then compared with the operative findings. We calculated the detection rates by 3D-CTA and DSA and evaluated the size differences of aneurysms diagnosed with 3D-DTA and those found at surgery. We also analyzed the locations and sizes of aneurysms missed by 3D-CTA and attempted to explain these false negatives. A total of 55 aneurysms were surgically confirmed in 40 patients. 48 of these were detected pre-operatively by 3D-CTA. Thus, the detection rate by 3D-CTA was 87%. The size difference of aneurysms as calculated by 3-D CTA and found operatively was as follows: less than 1 mm in 17 cases, within 1-2 mm in 15 cases, and more than 2 mm in 16 cases. Seven aneurysms were not detected by 3D-CTA. The major cause of these missed aneurysms was their small size. The undetected aneurysms were less than 2 mm in size, except for 2 instances of PCoA aneurysms. One case was not detected due to difficult image evaluation. A possible explanation of the one remaining missed aneurysms was the filling of the aneurismal sac by thrombosis. Though there were some limitations in the detection of aneurysms, 3D-CTA using 16-channel MDCT may provide sufficient pre-operative information for the management of patients with intracranial aneurysms in cases of emergency operations or DSA-failure

  20. Infundibular dilation and aneurysm at the origin of the posterior communicating artery: differential diagnosis by CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Min, Kyung-Jun; Yoon, Dae-Young [Hallym University College of Medicine, Department of Radiology, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of); Kim, Heung-Chul [Hallym University College of Medicine, Department of Radiology, Chuncheon Sacred Heart Hospital, Chuncheon (Korea, Republic of); Lee, Jong-Young; Cho, Byung-Moon [Hallym University College of Medicine, Department of Neurosurgery, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of)

    2014-11-15

    Infundibular dilation (ID) and aneurysm at the internal carotid artery (ICA)-posterior communicating artery (PComA) junction can be difficult to distinguish but may differ in clinical significance. The aim of this study was to evaluate the utility of CT angiography (CTA) in differentially diagnosing IDs and small unruptured aneurysms at the ICA-PComA junction. This retrospective study comprised 88 patients diagnosed with 107 protrusions (70 IDs and 37 aneurysms <5 mm; 19 bilateral lesions) at the ICA-PComA junction who underwent both CTA and digital subtraction angiography (DSA). Two neuroradiologists independently reviewed CTA and DSA images according to these criteria: (a) size (maximum dimension <3 or ≥3 mm), (b) shape (triangular or round/oval/irregular), (c) aneurysmal neck (absent or present), (d) horizontal direction (posteriomedial or posteriolateral), and (e) PComA origin (apex, no PComA, or base). The intermodality (between CTA and DSA) and interobserver (between the two readers) agreement were determined for each finding. We also evaluated the sensitivity and specificity of CTA for distinguishing ID and aneurysm, using DSA as the reference standard. The mean κ values of intermodality agreement for the size, shape, aneurysmal neck, horizontal direction, and PComA origin were 0.88, 0.87, 0.84, 0.71, and 0.56, respectively. All interobserver agreements of CTA and DSA were excellent. The sensitivity, specificity, and accuracy of CTA for differentiating aneurysms from IDs were 94.6, 100, and 98.0 %, respectively. CTA may be a useful noninvasive modality for differential diagnosis of ID and aneurysm at the ICA-PComA junction. (orig.)

  1. Cervical mycotic aneurysm in an infant. MRI findings and endovascular treatment

    International Nuclear Information System (INIS)

    Ramos Taboada, Luciana; Foa Torres, Gustavo; Tejada, Graciela; Castellari, Mario; Oulton, Carlos A.

    2004-01-01

    A case of cervical mycotic aneurysm in a 6-month-old infant is presented. Eight days after birth the preterm newborn had a perforated necrotizing enterocolitis. Treatment included abdominal percutaneous drainage and surgery. Hemo cultures grew staphylococcus aureus methicillin resistant. Antibiotic therapy was indicated with a favorable evolution. Five months later the infant showed a lateral cervical mass nad hemorrhagic fluid in her right external auditory canal. Ultrasound and MRI were performed. MRI demonstrated a heterogeneous fluid-containing neck mass, similar in appearance to a parapharyngeal hematoma, with flow void sign. Digital substraction angiography (DSA) was performed to highlight the vascular anatomy demonstrating a mycotic aneurysm adjacent to the ascendent pharyngeal artery. The endovascular treatment with Histoacryl-Lipiodol was successful without any technical or neurological complications. Mycotic aneurysm is a very rare, but potentially fatal complication in infants. In our case report, MRI and DSA provided an accurate diagnosis leading to a rapid endovascular therapy. (author)

  2. Transcatheter Coil Embolization of an Aneurysm of the Pancreatico-duodenal Artery with Occluded Celiac Trunk

    International Nuclear Information System (INIS)

    Weber, C.H.; Pfeifer, K.J.; Tato, F.; Reiser, M.; Rieger, J.

    2005-01-01

    We report on a case of a wide-necked aneurysm of the pancreatico-duodenal artery with occlusion of the celiac trunk in an asymptomatic patient. The aneurysm was considered to be at high risk of rupture. Successful embolization after interdisciplinary consultation was followed with color-coded duplex ultrasound (CCDS) demonstrating significant flow reduction. Three weeks later CCDS and angiography demonstrated exclusion of the aneurysm and a patent arterial supply of the liver and spleen fed by superior mesenteric artery (SMA) collaterals. The patient has done well so far, without major adverse clinical events or evidence for tissue necrosis of the liver, pancreas or spleen. Discussion of the case and review of the literature indicate that transcatheter embolization is the therapy of choice even in complicated cases

  3. Hemodynamic alterations after stent implantation in 15 cases of intracranial aneurysm.

    Science.gov (United States)

    Wang, Chao; Tian, Zhongbin; Liu, Jian; Jing, Linkai; Paliwal, Nikhil; Wang, Shengzhang; Zhang, Ying; Xiang, Jianping; Siddiqui, Adnan H; Meng, Hui; Yang, Xinjian

    2016-04-01

    Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In the current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and their association with the aneurysm location. We first retrospectively studied 15 aneurysm cases [8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms] treated with Enterprise stents and coils. Then, based on the patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. Before and after the stent deployment, the average wall shear stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; the spatially averaged flow velocity in the perpendicular plane of the aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post stent implantation, the WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4 % (P = 0.012) and 16.6 % (P = 0.018), respectively, and the flow velocity also reduced by 10.3 % (P = 0.029) and 10.5 % (P = 0.013), respectively. Changes in the WSS, flow velocity, and pressure were not significantly different between ICA-OphA and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in either aneurysm type. After the stent implantation, both the intra-aneurysmal flow velocity and WSS decreased independently of aneurysm type (ICA-OphA and PcoA). Little change was observed in peak systolic pressure.

  4. Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture

    Science.gov (United States)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2007-03-01

    The aim of this study is to characterize the different flows present at anterior communicating artery (AcoA) aneurysms and investigate possible associations with rupture. For that purpose, patient-specific computational models of 26 AcoA aneurysms were constructed from 3D rotational angiography images. Bilateral images were acquired in 15 patients who had both A1 segments of the anterior cerebral arteries and models were created by fusing the reconstructed left and right arterial trees. Computational fluid dynamics simulations were performed under pulsatile flow conditions. Visualizations of the flow velocity pattern were created to classify the aneurysms into the following flow types: A) inflow from both A1 segments, B) flow jet in the parent artery splits into three secondary jets, one enters the aneurysm and the other two are directed to the A2 segments, C) the parent artery jet splits into two secondary jets, one is directed to one of the A2 segments and the other enters the aneurysm before being directed to the other A2 segment, and D) the parent artery jet enters the aneurysm before being directed towards the A2 segments. The maximum wall shear stress in the aneurysm at the systolic peak (MWSS) was calculated. Most aneurysms in group A were unruptured and had the lowest MWSS. Group B had the same number of unruptured and ruptured aneurysms, and a low MWSS. Groups C and D had high rupture ratios, being the average MWSS significantly higher in group C. Finally, it was found that the MWSS was higher for ruptured aneurysms of all flow types.

  5. The effect of inlet waveforms on computational hemodynamics of patient-specific intracranial aneurysms.

    Science.gov (United States)

    Xiang, J; Siddiqui, A H; Meng, H

    2014-12-18

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic quantities that have been shown to predict aneurysm rupture, as well as maximal WSS (MWSS), energy loss (EL) and pressure loss coefficient (PLc). Sixteen pulsatile CFD simulations were carried out on four typical saccular aneurysms using 4 different waveforms and an identical inflow rate as inlet boundary conditions. Our results demonstrated that under the same mean inflow rate, different waveforms produced almost identical WSS distributions and WSS magnitudes, similar OSI distributions but drastically different OSI magnitudes. The OSI magnitude is correlated with the pulsatility index of the waveform. Furthermore, there is a linear relationship between aneurysm-averaged OSI values calculated from one waveform and those calculated from another waveform. In addition, different waveforms produced similar MWSS, EL and PLc in each aneurysm. In conclusion, inlet waveform has minimal effects on WSS, OSI distribution, MWSS, EL and PLc and a strong effect on OSI magnitude, but aneurysm-averaged OSI from different waveforms has a strong linear correlation with each other across different aneurysms, indicating that for the same aneurysm cohort, different waveforms can consistently stratify (rank) OSI of aneurysms. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Endovascular treatment of PICA aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mukonoweshuro, W.; Laitt, R.D.; Hughes, D.G. [Radiology Dept., Greater Manchester Neurosciences Unit, Hope Hospital, Salford, Manchester (United Kingdom)

    2003-03-01

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  7. Postprocedural Monitoring of Cerebral Aneurysms

    International Nuclear Information System (INIS)

    Kaehaerae, V.

    2006-01-01

    The treatment of intracranial aneurysms has been revolutionized since the introduction of electrolytically detachable platinum coils in 1991. Since this basic innovation, many refinements of the embolic materials and techniques have emerged. Today, in Europe, half of all aneurysms are treated endoarterially and this share is growing. The reassuring results of the International Subarachnoid Aneurysm Trial (ISAT) have changed the treatment strategy from neurosurgical clipping to embolization. However, the role of these alternative modes of treatment varies between institutions and countries. An angiographic follow-up pattern after endovascular treatment has remained largely undefined and in the same way there has been much diversity in applying alternative imaging modalities. Although some institutions continue to perform intervalled digital subtraction angiography, magnetic resonance angiography has assumed an increasing role. A vast majority of patients with embolized aneurysms are eligible to be monitored solely by non-contrast three-dimensional time-of-flight technique

  8. Management of aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Etminan, N; Macdonald, R L

    2017-01-01

    Spontaneous subarachnoid hemorrhage (SAH) affects people with a mean age of 55 years. Although there are about 9/100 000 cases per year worldwide, the young age and high morbidity and mortality lead to loss of many years of productive life. Intracranial aneurysms account for 85% of cases. Despite this, the majority of survivors of aneurysmal SAH have cognitive deficits, mood disorders, fatigue, inability to return to work, and executive dysfunction and are often unable to return to their premorbid level of functioning. The main proven interventions to improve outcome are aneurysm repair in a timely fashion by endovascular coiling rather than neurosurgical clipping when feasible and administration of nimodipine. Management also probably is optimized by neurologic intensive care units and multidisciplinary teams. Improved diagnosis, early aneurysm repair, administration of nimodipine, and advanced neurointensive care support may be responsible for improvement in survival from SAH in the last few decades. © 2017 Elsevier B.V. All rights reserved.

  9. Dissecting aneurysm of the cervical internal carotid artery

    International Nuclear Information System (INIS)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi.

    1987-01-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm. (author)

  10. Left coronary aneurysmal dilation and subaortic stenosis in a dog.

    Science.gov (United States)

    Hernandez, Juan L; Bélanger, Marie-Claude; Benoit-Biancamano, Marie-Odile; Girard, Christiane; Pibarot, Philippe

    2008-06-01

    A 6-month-old German shepherd dog was referred for evaluation of a cardiac murmur. Upon physical examination, the auscultated heart rate was 120 beats/min, and a grade IV/VI systolic heart murmur with a point of maximal intensity over the left heart base radiating up the neck was heard. The standard echocardiographic examination showed subaortic stenosis and an anechoic tubular structure extending from the sinus of Valsalva to the left ventricular posterior wall. Aneurysmal left coronary artery (CA) was confirmed by angiography. The dog was euthanized and post-mortem examination showed severe dilatation of the proximal left CA and confirmed the subaortic stenosis. Histopathology did not demonstrate abnormalities in the walls of the CA, aorta or pulmonary artery. The exact cause of the CA aneurysmal dilation remains unknown. Subaortic stenosis, elevated coronary vascular resistance or a congenital anomaly may have contributed to the dilation. To our knowledge, coronary aneurysmal dilation has never been described in dogs. Standard echocardiography provides reliable information on coronary anatomy.

  11. Bone cysts: unicameral and aneurysmal bone cyst.

    Science.gov (United States)

    Mascard, E; Gomez-Brouchet, A; Lambot, K

    2015-02-01

    Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Dynamic Contrast-Enhanced Magnetic Resonance Imaging as a Predictor of Outcome in Head-and-Neck Squamous Cell Carcinoma Patients With Nodal Metastases

    International Nuclear Information System (INIS)

    Shukla-Dave, Amita; Lee, Nancy Y.; Jansen, Jacobus F.A.; Thaler, Howard T.; Stambuk, Hilda E.; Fury, Matthew G.; Patel, Snehal G.; Moreira, Andre L.; Sherman, Eric; Karimi, Sasan; Wang, Ya; Kraus, Dennis; Shah, Jatin P.; Pfister, David G.

    2012-01-01

    Purpose: Dynamic contrast-enhanced MRI (DCE-MRI) can provide information regarding tumor perfusion and permeability and has shown prognostic value in certain tumors types. The goal of this study was to assess the prognostic value of pretreatment DCE-MRI in head and neck squamous cell carcinoma (HNSCC) patients with nodal disease undergoing chemoradiation therapy or surgery. Methods and Materials: Seventy-four patients with histologically proven squamous cell carcinoma and neck nodal metastases were eligible for the study. Pretreatment DCE-MRI was performed on a 1.5T MRI. Clinical follow-up was a minimum of 12 months. DCE-MRI data were analyzed using the Tofts model. DCE-MRI parameters were related to treatment outcome (progression-free survival [PFS] and overall survival [OS]). Patients were grouped as no evidence of disease (NED), alive with disease (AWD), dead with disease (DOD), or dead of other causes (DOC). Prognostic significance was assessed using the log-rank test for single variables and Cox proportional hazards regression for combinations of variables. Results: At last clinical follow-up, for Stage III, all 12 patients were NED. For Stage IV, 43 patients were NED, 4 were AWD, 11 were DOD, and 4 were DOC. K trans is volume transfer constant. In a stepwise Cox regression, skewness of K trans (volume transfer constant) was the strongest predictor for Stage IV patients (PFS and OS: p trans was the strongest predictor of PFS and OS in Stage IV HNSCC patients with nodal disease. This study suggests an important role for pretreatment DCE-MRI parameter K trans as a predictor of outcome in these patients.

  13. Comparison of 3D computer-aided with manual cerebral aneurysm measurements in different imaging modalities

    International Nuclear Information System (INIS)

    Groth, M.; Buhk, J.H.; Schoenfeld, M.; Goebell, E.; Fiehler, J.; Forkert, N.D.

    2013-01-01

    To compare intra- and inter-observer reliability of aneurysm measurements obtained by a 3D computer-aided technique with standard manual aneurysm measurements in different imaging modalities. A total of 21 patients with 29 cerebral aneurysms were studied. All patients underwent digital subtraction angiography (DSA), contrast-enhanced (CE-MRA) and time-of-flight magnetic resonance angiography (TOF-MRA). Aneurysm neck and depth diameters were manually measured by two observers in each modality. Additionally, semi-automatic computer-aided diameter measurements were performed using 3D vessel surface models derived from CE- (CE-com) and TOF-MRA (TOF-com) datasets. Bland-Altman analysis (BA) and intra-class correlation coefficient (ICC) were used to evaluate intra- and inter-observer agreement. BA revealed the narrowest relative limits of intra- and inter-observer agreement for aneurysm neck and depth diameters obtained by TOF-com (ranging between ±5.3 % and ±28.3 %) and CE-com (ranging between ±23.3 % and ±38.1 %). Direct measurements in DSA, TOF-MRA and CE-MRA showed considerably wider limits of agreement. The highest ICCs were observed for TOF-com and CE-com (ICC values, 0.92 or higher for intra- as well as inter-observer reliability). Computer-aided aneurysm measurement in 3D offers improved intra- and inter-observer reliability and a reproducible parameter extraction, which may be used in clinical routine and as objective surrogate end-points in clinical trials. (orig.)

  14. Experimental study on blood flow patterns through the phantoms of the intracranial arterial aneurysms using color Doppler imaging

    International Nuclear Information System (INIS)

    Chung, Tae Sub; Jeong, Eun Kee; Rhim, Yoon Chul; Kim, Sung Bin; Lee, Dong Hoon; Kim, Dae In

    1994-01-01

    The occurrence, growth, thrombosis, and rupture of intracranial saccular aneurysms can be directly related to the effect of hemodynamic forces. We developed the phantom flow models and compared with the computer simulation program to analyse the flow pattern and hemodynamics that might be responsible for the intracranial arterial aneurysms. We designed the arterial phantoms of three major sites of intracranial arterial aneurysm ; 1) basilar artery tip, 2) internal carotid artery bifurcation, 3) curved area of internal carotid artery. Flow patterns in the aneurysmal portion of phantoms were evaluated with color Doppler system on the connection with automatic closed type of circulation system. Then, we compared the results with computer simulation. The hemodynamic characteristics of the phantoms were identical with those obtained by computerisation's. Three distinct zones of flow were identified by color Doppler studies on the aneurysm of the curved area of an internal carotid artery : 1) an inflow zone entering the aneurysm at the distal aspect of its orifice, 2) an outflow zone exiting the aneurysm at the proximal aspect of its orifice, 3) a central slow vortex.However, the phantoms of basilar artery tip and artery bifurcation showed a direct inflow stream at the dome of an aneurysm. Flow dynamics in the various phantoms of the aneurysms can be successfully evaluated with color Doppler imaging, and were consistent with those predicted by computer simulations

  15. Clinical value of homodynamic numerical simulation applied in the treatment of cerebral aneurysm.

    Science.gov (United States)

    Zhang, Hailin; Li, Li; Cheng, Chongjie; Sun, Xiaochuan

    2017-12-01

    Our objective was to evaluate the clinical value of numerical simulation in diagnosing cerebral aneurysm based on the analysis of numerical simulation of hemodynamic model. The experimental method used was the numerical model of cerebral aneurysm hemodynamic, and the numerical value of blood flow at each point was analyzed. The results showed that, the wall shear stress (WSS) value on the top of CA1 was significantly lower than that of the top (Pvalue of each point on the CA2 tumor was significantly lower than that of tumor neck (Pvalue on the tumor top and tumor neck between CA1 and CA2 had no significant difference (P>0.05); the unsteady index of shear (UIS) value at the points of 20 had distinctly changed, the wave range was 0.6-1.5; the unsteady index of pressure value of every point was significantly lower than UIS value, the wave range was 0.25-0.40. In conclusion, the application of cerebral aneurysm hemodynamic research can help doctors to diagnose cerebral aneurysm more precisely and to grasp the opportunity of treatment during the formulating of the treatment strategies.

  16. Anatomical Features and Early Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm from a Korean Multicenter Registry.

    Science.gov (United States)

    Kwon, Hyunwook; Lee, Do Yun; Choi, Soo Jin Na; Park, Ki Hyuk; Min, Seung-Kee; Chang, Jeong-Hwan; Huh, Seung; Jeon, Yong Sun; Won, Jehwan; Byun, Seung Jae; Park, Sang Jun; Jang, Lee Chan; Kwon, Tae-Won

    2015-09-01

    To introduce a nation-based endovascular aneurysm repair (EVAR) registry in South Korea and to analyze the anatomical features and early clinical outcomes of abdominal aortic aneurysms (AAA) in patients who underwent EVAR. The Korean EVAR registry (KER) was a template-based online registry developed and established in 2009. The KER recruited 389 patients who underwent EVAR from 13 medical centers in South Korea from January 2010 to June 2010. We retrospectively reviewed the anatomic features and 30-day clinical outcomes. Initial deployment without open conversion was achieved in all cases and procedure-related 30-day mortality rate was 1.9%. Anatomic features showed the following variables: proximal aortic neck angle 48.8±25.7° (mean±standard deviation), vertical neck length 35.0±17.2 mm, aneurysmal sac diameter 57.2±14.2 mm, common iliac artery (CIA) involvement in 218 (56.3%) patients, and median right CIA length 34.9 mm. Two hundred and nineteen (56.3%) patients showed neck calcification, 98 patients (25.2%) had neck thrombus, and the inferior mesenteric arteries of 91 patients (23.4%) were occluded. Anatomical features of AAA in patients from the KER were characterized as having angulated proximal neck, tortuous iliac artery, and a higher rate of CIA involvement. Long-term follow-up and ongoing studies are required.

  17. The Effect of Inlet Waveforms on Computational Hemodynamics of Patient-Specific Intracranial Aneurysms

    OpenAIRE

    Xiang, J.; Siddiqui, A.H.; Meng, H.

    2014-01-01

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic qu...

  18. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes S.

    2010-01-01

    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective...... surgery of symptomfree AAA. In order to fulfil all WHO, European, and Danish criteria for screening, a randomised hospitalbased screening trial of 12,639 65-73 year old men in Viborg County (Denmark) was initiated in 1994. It seemed that US screening is a valid, suitable and acceptable method of screening...... patients without previous hospital discharge diagnoses due to cardiovascular disease than among similar men without AAA. The absolute risk difference after 5 years was 16%. So, they will benefit from general cardiovascular preventive action as smoking cessation, statins and low-dose aspirin, which could...

  19. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...... patients, 51 (9%) of whom died within the first 48 hours. Of the 502 patients who survived for more than 48 hours, 109 required ICU therapy for more than 48 hours, whereas 393 patients were in the ICU for less than 48 hours. The incidence of preoperative risk factors was similar for the two groups...... combined failed to permit identification of patients in whom the perioperative survival rate was 0%. Even 20% of patients with multiorgan failure survived for 6 months. Of those patients who needed ICU therapy for more than 48 hours, 41 (38%) were alive at the end of 1988. In response to a questionnaire...

  20. Flow and wall shear stress characterization following endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model

    NARCIS (Netherlands)

    Boersen, Johannes T.; Groot Jebbink, Erik; Versluis, Michel; Slump, Cornelis H.; Ku, David N.; de Vries, Jean-Paul P.M.; Reijnen, Michel M.P.J.

    2017-01-01

    Background Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is

  1. Stent-assisted coil embolization for cavernous carotid artery aneurysms.

    Science.gov (United States)

    Kono, Kenichi; Shintani, Aki; Okada, Hideo; Tanaka, Yuko; Terada, Tomoaki

    2014-01-01

    Internal carotid artery (ICA) occlusion with or without a bypass surgery is the traditional treatment for cavernous sinus (CS) aneurysms with cranial nerve (CN) dysfunction. Coil embolization without stents frequently requires retreatment because of the large size of CS aneurysms. We report the mid-term results of six unruptured CS aneurysms treated with stent-assisted coil embolization (SACE). The mean age of the patients was 72 years. The mean size of the aneurysms was 19.8 mm (range: 13-26 mm). Before treatment, four patients presented with CN dysfunction and two patients had no symptoms. SACE was performed under local or general anesthesia in three patients each. Mean packing density was 29.1% and tight packing was achieved. There were no neurological complications. CN dysfunction was cured in three patients (75%) and partly resolved in one patient (25%). Transient new CN dysfunction was observed in two patients (33%). Clinical and imaging follow-up ranged from 6 to 26 months (median: 16 months). Recanalization was observed in three patients (50%; neck remnant in two patients and dome filling in one patient), but no retreatment has yet been required. No recurrence of CN dysfunction has occurred yet. In summary, SACE increases packing density and may reduce requirement of retreatment with an acceptable cure rate of CN dysfunction. SACE may be a superior treatment for coiling without stents and be an alternative treatment of ICA occlusion for selected patients, such as older patients and those who require a high-flow bypass surgery or cannot receive general anesthesia.

  2. Blood flow in intracranial aneurysms treated with Pipeline embolization devices: computational simulation and verification with Doppler ultrasonography on phantom models

    Directory of Open Access Journals (Sweden)

    Anderson Chun On Tsang

    2015-04-01

    Full Text Available Purpose: The aim of this study was to validate a computational fluid dynamics (CFD simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms. Methods: Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations. Results: CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography. Conclusion: The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.

  3. Performance of long J-shaped coils in large and giant intracranial aneurysms: an in vitro study

    International Nuclear Information System (INIS)

    Tokunaga, K.; Tanaka, N.; Sugiu, K.; Levrier, O.; Martin, J.B.; Ruefenacht, D.A.

    2002-01-01

    We evaluated the performance of long straight coils (Detach-18 trademark J-shaped coils) in large and giant in-vitro aneurysms. The coils consisted of a distal semicircular part 7 or 15 mm in diameter and a proximal 70 cm straight part having three types of stiffness: soft, standard, and stiff. We first investigated the ease of passage through a microcatheter in a realistic cerebral vessel model. Second, we made silicone models simulating lateral-type aneurysms of various spherical dome diameters (12, 15, 20 and 30 mm) and neck sizes (3-10 mm; dome-to-neck ratio approximately 3:1) and connected them to a pulsating circulatory pump. We evaluated the anchoring and folding patterns of the coils, stability of the microcatheter and coils in the aneurysm, and smoothness of delivery and retrieval of coils. Third, we compared the conformability of a coil in a large, irregular aneurysm with that of a spiral coil. The long J-shaped coils were easily advanced and retrieved through a microcatheter in a tortuous vessel model. In 12 mm spherical aneurysms, each coil made a complex framework, and knot formation or damage to the coil during withdrawal was often observed. In 15 mm aneurysms, the coils were all easily delivered and retrieved; standard-stiffness coils adapted best to this size. In 20 mm aneurysms, frameworks were less complex but still good with a standard or stiff coil, but those with soft coil were unstable and changed significantly within 3 min of detachment due to gravity and pulsatile flow. In 30 mm aneurysms, soft coils filled only the lower part during introduction, whereas a stiff coil still made a favourable framework. Conformability of a long J-shaped coil was superior to that of a spiral coil in a large, irregular aneurysm. Long J-shaped coils conform well to various configurations of large and giant aneurysms and can shorten procedures since a larger implant volume can be delivered with a single coil. Their principle of action may promote more favourable

  4. Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography.

    Science.gov (United States)

    Beller, Ebba; Klopp, David; Göttler, Jens; Kaesmacher, Johannes; Zimmer, Claus; Kirschke, Jan S; Prothmann, Sascha

    2016-01-01

    Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤ .001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤ .001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤ .01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05). Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.

  5. Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography.

    Directory of Open Access Journals (Sweden)

    Ebba Beller

    Full Text Available Stent-assisted coil embolization (SACE plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms.31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1, respectively, more remote from the aneurysm neck (δ2 were graphically determined in 2D angiography projections.Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM of α = 119° (±6.5° pretreatment to 130° (±6.6° posttreatment (P ≤ .001, δ1 = 129° (±6.4° to 139° (±6.1°, (P ≤ .001 and δ2 = 115° (±8.4° to 126° (±7.5°, (P ≤ .01. Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05. The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01. Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05.Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.

  6. Coil embolization of anterior circulation aneurysms supported by the solitaire trademark AB neurovascular remodeling device

    International Nuclear Information System (INIS)

    Klisch, Joachim; Clajus, Christin; Sychra, Vojtech; Eger, Cornelia; Strasilla, Christoph; Rosahl, Steffen; Gerlach, Ruediger; Baer, Ingrid; Hoch, Heinrich; Herbon, Uta; Borota, Ljubisa; Jonasson, Per; Liebig, Thomas

    2010-01-01

    The purpose of the study is to evaluate patients with wide-necked or complex aneurysms of the anterior circulation who underwent Solitaire trademark AB Neurovascular Remodeling Device-assisted coil embolization. From February 2008 to March 2009, consecutive data were collected from 45 patients with anterior circulation aneurysms. Eighteen of the patients presented with acute subarachnoid hemorrhage. Forty-six aneurysms were treated with the aid of different applications (n=49) of the Solitaire trademark AB Remodeling Device followed by standard coiling procedure (n = 43) using bioactive coils or/and bare coils. Successful positioning of the remodeling device was obtained in 95.9% of the cases. There were two thromboembolic complications (4.1%) and one severe vasospasm requiring retrieval of the device. Permanent procedural morbidity was observed in one patient (2%). The proportion of patients in whom Raymond class 1 occlusion was obtained was 53.5% (n=23). Raymond class 2 occlusion was achieved in 42% (n=18) and Raymond class 3 occlusion in 4.7% (n=2). Thirty-nine patients left the hospital with a good clinical status. The initial technical and clinical results of Solitaire trademark AB device-assisted coiling of aneurysms in the anterior circulation are highly encouraging. This technique may enhance the possibilities of the endovascular treatment of these aneurysms in clinical routine. (orig.)

  7. A non-invasive immobilization system and related quality assurance for dynamic intensity modulated radiation therapy of intracranial and head and neck disease

    International Nuclear Information System (INIS)

    Tsai Jensan; Engler, Mark J.; Ling, Marilyn N.; Wu, Julian K.; Kramer, Bradley; Dipetrillo, Thomas; Wazer, David E.

    1999-01-01

    Purpose: To develop and implement a non-invasive immobilization system guided by a dedicated quality assurance (QA) program for dynamic intensity-modulated radiotherapy (IMRT) of intracranial and head and neck disease, with IMRT delivered using the NOMOS Corporation's Peacock System and MIMiC collimator. Methods and Materials: Thermoplastic face masks are combined with cradle-shaped polyurethane foaming agents and a dedicated quality assurance program to create a customized headholder system (CHS). Plastic shrinkage was studied to understand its effect on immobilization. Fiducial points for computerized tomography (CT) are obtained by placing multiple dabs of barium paste on mask surfaces at intersections of laser projections used for patient positioning. Fiducial lines are drawn on the cradle along laser projections aligned with nasal surfaces. Lateral CT topograms are annotated with a crosshair indicating the origin of the treatment planning and delivery coordinate system, and with lines delineating the projections of superior-inferior field borders of the linear accelerator's secondary collimators, or with those of the fully open MIMiC. Port films exposed with and without the MIMiC are compared to annotated topograms to measure positional variance (PV) in superior-inferior (SI), right-left (RL), and anterior posterior (AP) directions. MIMiC vane patterns superposed on port films are applied to verify planned patterns. A 12-patient study of PV was performed by analyzing positions of 10 anatomic points on repeat CT topograms, plotting histograms of PV, and determining average PV. Results and Discussion: A 1.5 ± 0.3 mm SD shrinkage per 70 cm of thermoplastic was observed over 24 h. Average PV of 1.0 ± 0.8, 1.2 ± 1.1, and 1.3 ± 0.8 mm were measured in SI, AP, and RL directions, respectively. Lateral port films exposed with and without the MIMiC showed PV of 0.2 ± 1.3 and 0.8 ± 2.2 mm in AP and SI directions. Vane patterns superimposed on port films

  8. Endovascular Exclusion of Renal Artery Aneurysm

    International Nuclear Information System (INIS)

    Andersen, Poul Erik; Rohr, Nils

    2005-01-01

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90 o , but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable

  9. Carotid artery aneurysm resulting in myxedema coma

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Lamos

    2015-06-01

    Full Text Available Intra-sellar aneurysms are a rare, but important consideration when evaluating pituitary masses. Identification of aneurysms is critical to appropriate treatment and avoiding perilous consequences. These vascular aneurysms can result in severe endocrine dysfunction due to mass effect, stripping of the vascular supply to the pituitary, or hemorrhage. Here we describe a novel case of spontaneous myxedema coma and pituitary apoplexy secondary to a large internal carotid artery aneurysm.

  10. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients.

    Science.gov (United States)

    Sedat, Jacques; Chau, Yves; Gaudart, Jean; Sachet, Marina; Beuil, Stephanie; Lonjon, Michel

    2018-02-01

    Coiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique. We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months. No procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion. Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.

  11. Transcatheter Coil Embolization of Splenic Artery Aneurysm

    International Nuclear Information System (INIS)

    Yamamoto, Satoshi; Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko; Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

    2008-01-01

    The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm

  12. [Albert Einstein and his abdominal aortic aneurysm].

    Science.gov (United States)

    Cervantes Castro, Jorge

    2011-01-01

    The interesting case of Albert Einstein's abdominal aortic aneurysm is presented. He was operated on at age 69 and, finding that the large aneurysm could not be removed, the surgeon elected to wrap it with cellophane to prevent its growth. However, seven years later the aneurysm ruptured and caused the death of the famous scientist.

  13. Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair.

    Science.gov (United States)

    Donayre, Carlos E; Zarins, Christopher K; Krievins, Dainis K; Holden, Andrew; Hill, Andrew; Calderas, Carlos; Velez, Jaime; White, Rodney A

    2011-03-01

    All current aortic endografts depend on proximal and distal fixation to prevent migration. However, migration and rupture can occur, particularly in patients with aortic necks that are short or angulated, or both. We present our initial clinical experience with a new sac-anchoring endoprosthesis designed to anchor and seal the device within the aneurysm sac. The initial worldwide experience using a new endoprosthesis for the treatment of aortic aneurysms (Nellix Endovascular, Palo Alto, Calif) was reviewed. The endoprosthesis consists of dual balloon-expandable endoframes surrounded by polymer-filled endobags designed to obliterate the aneurysm sac and maintain endograft position. Clinical results and follow-up contrast computed tomography (CT) scans at 30 days and 6 and 12 months were reviewed. The endograft was successfully deployed in 21 patients with infrarenal aortic aneurysms measuring 5.7 ± 0.7 cm (range, 4.3-7.4 cm). Two patients with common iliac aneurysms were treated with sac-anchoring extenders that maintained patency of the internal iliac artery. Infusion of 71 ± 37 mL of polymer (range, 19-158 mL) into the aortic endobags resulted in complete aneurysm exclusion in all patients. Mean implant time was 76 ± 35 minutes, with 33 ± 17 minutes of fluoroscopy time and 180 ± 81 mL of contrast; estimated blood loss was 174 ± 116 mL. One patient died during the postoperative period (30-day mortality, 4.8%), and one died at 10 months from non-device-related causes. During a mean follow-up of 8.7 ± 3.1 months and a median of 6.3 months, there were no late aneurysm- or device-related adverse events and no secondary procedures. CT imaging studies at 6 months and 1 year revealed no increase in aneurysm size, no device migration, and no new endoleaks. One patient had a limited proximal type I endoleak at 30 days that resolved at 60 days and remained sealed. One patient has an ongoing distal type I endoleak near the iliac bifurcation, with no change in aneurysm

  14. 3D angiography in the evaluation of intracranial aneurysms before and after treatment. Initial experience

    International Nuclear Information System (INIS)

    Lauriola, Walter; Nardella, Michele; Strizzi, Vincenzo; Florio, Francesco; Cali, Alessandro; D'Angelo, Vincenzo

    2005-01-01

    Purpose: The aim of the study is to evaluate the advantages of 3D angiography as compared to 2D angiography in assessing intracranial aneurysms before and after treatment and, in particular, in selecting and planning the correct treatment. Materials and methods: Thirty intracranial aneurysms were retrospectively reviewed before and after treatment. The study population consisted of 12 men and 18 women (age range: 35-77 years; mean age: 58 years). Eighteen aneurysms were treated surgically, 10 endovascularly and 2 with combined treatment. The 2D and 3D finding before and after the treatment were compared , and the pre-treatment angiographic images were compared with surgical findings. The following parameters were assessed and compared: aneurysmal sac and neck size, vascular involvement and evaluation of post-treatment residual mass. Results: On the 2D DSA images, visualisation of the sac and neck was optimal in 45% and 15% of cases, adequate in 10% and 35% of cases and inadequate in 5% and 50% of cases, respectively. On the 3D DSA images, visualisation of the sac and neck was optimal in 100% of cases. Three-dimensional DSA was able to detect 8 aneurysms with vessel involvement in all cases (100%). Of these, four (50%) went undetected on 2D DSA; in two cases, two-dimensional DSA erroneously detected the presence of vascular involvement (false positive). Three-dimensional angiography proved superior to 2D angiography in the evaluation of the residual aneurysms treated with clipping. Finally, 3D DSA was able to reduce the number of the radiographic projections, the quantity of contrast medium, the time and associated risks necessary for a precise evaluation of the aneurysm. Conclusions: In our first experience, 3D DSA proved useful in reducing the risks and diagnostic time as well as in selecting and planning the treatment. Moreover, it improved the operating conditions of both surgical and endovascular treatment. Technological advances in this field will enable the

  15. Unraveling the relationship between arterial flow and intra-aneurysmal hemodynamics.

    Science.gov (United States)

    Morales, Hernán G; Bonnefous, Odile

    2015-02-26

    Arterial flow rate affects intra-aneurysmal hemodynamics but it is not clear how their relationship is. This uncertainty hinders the comparison among studies, including clinical evaluations, like a pre- and post-treatment status, since arterial flow rates may differ at each time acquisition. The purposes of this work are as follows: (1) To study how intra-aneurysmal hemodynamics changes within the full physiological range of arterial flow rates. (2) To provide characteristic curves of intra-aneurysmal velocity, wall shear stress (WSS) and pressure as functions of the arterial flow rate. Fifteen image-based aneurysm models were studied using computational fluid dynamics (CFD) simulations. The full range of physiological arterial flow rates reported in the literature was covered by 11 pulsatile simulations. For each aneurysm, the spatiotemporal-averaged blood flow velocity, WSS and pressure were calculated. Spatiotemporal-averaged velocity inside the aneurysm linearly increases as a function of the mean arterial flow (minimum R(2)>0.963). Spatiotemporal-averaged WSS and pressure at the aneurysm wall can be represented by quadratic functions of the arterial flow rate (minimum R(2)>0.996). Quantitative characterizations of spatiotemporal-averaged velocity, WSS and pressure inside cerebral aneurysms can be obtained with respect to the arterial flow rate. These characteristic curves provide more information of the relationship between arterial flow and aneurysm hemodynamics since the full range of arterial flow rates is considered. Having these curves, it is possible to compare experimental studies and clinical evaluations when different flow conditions are used. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Feasibility of Using Intravascular Ultrasonography for Assessment of Giant Cavernous Aneurysm after Endovascular Treatment: A Technical Report

    Science.gov (United States)

    Majidi, Shahram; Grigoryan, Mikayel; Tekle, Wondwossen G; Watanabe, Masaki; Qureshi, Adnan I

    2012-01-01

    Introduction Intravascular ultrasonography (IVUS) has been shown as a valuable adjunct imaging tool during endovascular procedures but its value in detection of any recurrence during follow up after endovascular coil embolization of large and giant intracranial aneurysms is not reported. Methods A 41 years old man who had been treated using stent assisted coil embolization for cavernous segment aneurysm of the left internal carotid artery underwent 60 month angiographic follow up. Concurrently, IVUS catheter was advanced under fluoroscopic guidance inside the cavernous portion of the left internal carotid artery. Then IVUS images were used to visualize the stent, coil loops, and aneurysm neck. Results The angiographic images were limited because of superimposition of the aneurysm on the parent vessel in all projections. IVUS images demonstrated that the stent was patent along its whole length and there was no sign of stent deformity or in-stent thrombosis. Loops of the coil were visualized as hyperechoic signals inside the aneurysm and there was no sign of herniated loops of coil inside the stent. Conclusion In this case report, we observed that adjunct use of IVUS can provide valuable information not ascertained by angiography during follow up assessment of coil embolized aneurysm. PMID:22737259

  17. A case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography

    International Nuclear Information System (INIS)

    Fukui, Keiji; Sadamoto, Kazuhiko; Ohue, Shiro; Takeda, Sadanori; Kimura, Hideki; Sakaki, Saburo.

    1986-01-01

    One case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography is reported. A 44-year-old female slipped and hit her head without loss of consciousness, one month ago. Recently she complained of headaches and visited the department of Neurosurgery, Washokai Sadamoto Hospital on May 21, 1985. There were no physical and neurological signs on examination. Plain CT scans showed a crescent-shaped high density area in the left frontal region with a slight mass sign. She was diagnosed as having a possible chronic subdural hematoma and further examination was recommended. Biplane ultrafast overlapping cerebral computed angiotomograms clearly demonstrated a so-called avascular area delineated by enhanced superficial cerebral vessels with contrast medium. Furthermore, a marked high density mass measuring 8 mm x 10 mm x 6 mm in diameters was simultaneously demonstrated around the right anterior clinoid process on the same image, suggesting a cerebral aneurysm. Right carotid angiograms showed a right internal carotid-posterior communicating junction aneurysm. The irrigation of the left chronic subdural hematoma was carried out on May 24 and the neck clipping of the right IC-PC junction aneurysm was done two weeks later. During the operation, there were no findings suggesting a previous subarachnoid hemorrhage from the aneurysm, but a bleb was found on the aneurysm. The post-operative course was uneventful. (J.P.N.)

  18. CT and angiographic analysis of posterior communicating artery aneurysms: What factors influence the amount of subarachnoid blood?

    International Nuclear Information System (INIS)

    Kim, Young Min; Jung, Kun Sik; Rho, Myung Ho; Choi, Pil Youb; Sung, Young Soon; Kwon, Jae Soo; Lee, Sang Wook

    1998-01-01

    To determine how clinical and angiographic factors relate to the amount of subarachnoid blood detected by computerized tomography in patients with a ruptured aneurysm. Between January 1996 and December 1997, 22 patients with a posterior communicating artery aneurysm were retrospectively evaluated. Oval(three of four cases), funnel(both cases), and daughter-sac (four of five cases) types of aneurysmal sac were found among the 13 patients with a large amount of subarachnoid blood;eight of these had a past history of hyertension or diabetes. Seven of eleven cases of cylindricaltype aneurysmal sac were found among the 9 patients with a small amount of sularachnoid blood;eight of these had no past history of hypertension or diabetes. The average S/N ratio (ratio of maximum sac length to neck diameter) of patients with a small amount of blood was higher than that of patients with a large amount of blood(2.72 vs 2.07). Although many factors influence the amount of subarachnoid blood in an aneurysmal rupture, we found that a large amount of blood was frequently present in the oval, funnel and daughter sac types of aneurysm, when S/N ratio was low, and when an underlying disease such as hypertension or diabetes was present. Conversely, a small amount of blood was present in the cylindrical type, when S/N ratio was high, and where there was no underlying disease.=20

  19. MR angiography in the follow-up of coiled cerebral aneurysms after treatment with Guglielmi detachable coils

    International Nuclear Information System (INIS)

    Nome, T.; Bakke, S. J.; Nakstad, P. H.

    2002-01-01

    Purpose: Intra-arterial digital subtraction angiography (DSA) has been considered the gold standard examination in the follow-up of patients treated with Guglielmi detachable coils (GDCs). However, DSA is an invasive and expensive investigation and results in exposure to ionising radiation to both patient and operator. The aim of this study was to compare MR angiography (MRA) with DSA with regard to patency of the occlusion of aneurysms following GDC treatment. Material and Methods: We performed 75 MRA and DSA examinations on 51 patients treated with GDCs. The examinations were performed 3-36 months after embolisation and the interval between MRA and DSA was less than 1 week. Hard copies of both studies were interpreted retrospectively and independently for residual flow within the aneurysm, residual aneurysmal neck, and parent and branch vessel flow. Results: Patency status of parent and branch vessel flow was correctly identified with MRA in all patients except 1. The sensitivity of MRA in revealing residual flow within the aneurysm was 97%. The specificity in ruling out residual flow within the aneurysm was 91%. Conclusion: MRA may replace DSA in the long-term follow-up of coiled cerebral aneurysms. The initial follow-up examination should, however, include both modalities

  20. Fabrication of cerebral aneurysm simulator with a desktop 3D printer.

    Science.gov (United States)

    Liu, Yu; Gao, Qing; Du, Song; Chen, ZiChen; Fu, JianZhong; Chen, Bing; Liu, ZhenJie; He, Yong

    2017-05-17

    Now, more and more patients are suffering cerebral aneurysm. However, long training time limits the rapid growth of cerebrovascular neurosurgeons. Here we developed a novel cerebral aneurysm simulator which can be better represented the dynamic bulging process of cerebral aneurysm The proposed simulator features the integration of a hollow elastic vascular model, a skull model and a brain model, which can be affordably fabricated at the clinic (Fab@Clinic), under $25.00 each with the help of a low-cost desktop 3D printer. Moreover, the clinical blood flow and pulsation pressure similar to the human can be well simulated, which can be used to train the neurosurgical residents how to clip aneurysms more effectively.

  1. Neck curve polynomials in neck rupture model

    International Nuclear Information System (INIS)

    Kurniadi, Rizal; Perkasa, Yudha S.; Waris, Abdul

    2012-01-01

    The Neck Rupture Model is a model that explains the scission process which has smallest radius in liquid drop at certain position. Old fashion of rupture position is determined randomly so that has been called as Random Neck Rupture Model (RNRM). The neck curve polynomials have been employed in the Neck Rupture Model for calculation the fission yield of neutron induced fission reaction of 280 X 90 with changing of order of polynomials as well as temperature. The neck curve polynomials approximation shows the important effects in shaping of fission yield curve.

  2. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    Su, I. Chang; Willinsky, Robert A.; Agid, Ronit; Fanning, Noel F.

    2014-01-01

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development. We performed a retrospective analysis of consecutively treated unruptured aneurysms between January 2000 and December 2011. The presence and evolution of wall enhancement and perianeurysmal edema on MRI after endovascular treatment were analyzed. Variable factors were compared among aneurysms with and without edema. One hundred thirty-two unruptured aneurysms in 124 patients underwent endovascular treatment. Eighty-five (64.4 %) aneurysms had wall enhancement, and 9 (6.8 %) aneurysms had perianeurysmal brain edema. Wall enhancement tends to persist for years with two patterns identified. Larger aneurysms and brain-embedded aneurysms were significantly associated with wall enhancement. In all edema cases, the aneurysms were embedded within the brain and had wall enhancement. Progressive thickening of wall enhancement was significantly associated with edema. Edema can be symptomatic when in eloquent brain and stabilizes or resolves over the years. Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended. (orig.)

  3. Coil embolization of an enlarging fusiform myxomatous cerebral aneurysm

    Directory of Open Access Journals (Sweden)

    Frances Lazarow, MD

    2018-04-01

    Full Text Available Myxomatous cerebral aneurysms are rare sequelae of cardiac atrial myxoma. These aneurysms are generally fusiform, multiple, and distal. Pathogenesis and evolution of these aneurysms is still debated. There are currently no guidelines on the management of aneurysms secondary to atrial myxoma. We present a case of a 52-year-old man with multiple fusiform aneurysms 3 years after resection of a left atrial myxoma. One of these aneurysms was followed with cerebral angiography and showed substantial interval enlargement. This aneurysm was subsequently embolized. All aneurysms were stable 6 months post-embolization. Keywords: Myxomatous aneurysm, Fusiform, Coil embolization

  4. Dynamic contrast-enhanced MRI evaluates the early response of human head and neck tumor xenografts following anti-EMMPRIN therapy with cisplatin or irradiation.

    Science.gov (United States)

    Kim, Hyunki; Hartman, Yolanda E; Zhai, Guihua; Chung, Thomas K; Korb, Melissa L; Beasley, Timothy M; Zhou, Tong; Rosenthal, Eben L

    2015-10-01

    To assess the early therapeutic effects of anti-EMMPRIN (extracellular matrix metalloprotease inducer) antibody with/without cisplatin or X-ray radiation in head and neck cancer mouse models using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Mice bearing SCC1 (or OSC19) tumor xenografts were treated with anti-EMMPRIN antibody, radiation, cisplatin, or anti-EMMPRIN antibody plus cisplatin (or radiation) for a week (n = 4-5 per group). DCE-MRI was carried out on a 9.4T small animal MR scanner on days 0, 3, and 7, and K(trans) values were averaged in a 0.5-mm-thick peripheral tumor region. Ki67 and CD31 staining were implemented for all tumors after imaging. The K(trans) changes of SCC1 and OSC19 tumors treated with anti-EMMPRIN antibody for 3 days were -18 ± 8% and 4 ± 7%, respectively, which were significantly lower than those of control groups (39 ± 5% and 45 ± 7%; P = 0.0025 and 0.0220, respectively). When cisplatin was added, those were -42 ± 9% and -44 ± 9%, respectively, and with radiation, -45 ± 9% and -27 ± 10%, respectively, which were also significantly lower than those of control groups (P EMMPRIN antibody with/without cisplatin or radiation, the mean K(trans) change for 3 days was significantly correlated with the mean tumor volume change for 7 days (r = 0.74, P = 0.0346), Ki67-expressing cell density (r = 0.96, P = 0.0001), and CD31 density (r = 0.84, P = 0.0084). DCE-MRI might be utilized to assess the early therapeutic effects of anti-EMMPRIN antibody with/without chemotherapy or radiotherapy in head and neck cancer. © 2015 Wiley Periodicals, Inc.

  5. Renal aneurysm and arteriovenous fistula

    International Nuclear Information System (INIS)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Padua Univ.

    1990-01-01

    Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.)

  6. Spontaneous non aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Bian Jieyong; Wang Zhong; Zhou Dai

    2000-01-01

    Objective: To study the etiology and the treatment of spontaneous non-aneurysmal subarachnoid hemorrhage. Methods: Twenty five cases of cerebral vessel angiography negative patients were analysed retrospectively, the majority of them had been undergone CT, DSA, MRI examination in order to define the etiological factor. Results: Among them, there was 1 case of spinal arteria-vena malformation, 1 case of hemorrhagic blood and 2 cases according to the revealing of MRI could be explained as bled vascular-occult malformation or cavernous angioma. Conclusion: The management and prognosis of patients in whom non-aneurysm is founded on the initial angiogram depends on the pattern of hemorrhage of the initial CT scanning, repeated angiography should be avoided for the case of premise encephalic non-aneurysmal SAH and MRI examination may be indicated to defining of etiological factors

  7. The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage

    International Nuclear Information System (INIS)

    Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

    2014-01-01

    The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. BSCTA is easily accessible, less time consuming, and most importantly, a non

  8. The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage

    Science.gov (United States)

    Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

    2014-01-01

    Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Results: Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. Conclusions: BSCTA is

  9. Ruptured gastroepiploic artery aneurysm: A case report

    Directory of Open Access Journals (Sweden)

    Ahmad S. Ashrafi

    Full Text Available Introduction: Gastroepiploic artery aneurysms are extremely rare, with few reported cases in the literature. The risk of rupture however, is high and thus warrants attention. Presentation of case: Here we present a rare case of a women who presented to the emergency department in shock and was found to have a ruptured gastroepiploic artery aneurysm during surgical exploration. Suture ligation of the aneurysm was completed. Discussion: Although rare, gastroepiploic artery aneurysms have up to a 90% rate of rupture and therefore require intervention. A laparoscopic approach has been described however, in cases where rupture has occurred, urgent laparotomy and control of hemorrhage is needed. Conclusion: We describe a rare case of a ruptured gastroepiploic aneurysm that was successfully managed with urgent laparotomy and aneurysmal resection. Keywords: Gastroepiploic, Aneurysm, Hemorrhage, Case report

  10. Head and neck cancer

    International Nuclear Information System (INIS)

    Vogl, S.E.

    1988-01-01

    This book contains 10 chapters. Some of the titles are: Combined Surgical Resection and Irradiation for Head and Neck Cancers; Analysis of Radiation Therapy Oncology Group Head and Neck Database: Identification of Prognostic Factors and the Re-evaluation of American Joint Committee Stages; Combined Modality Approach to Head and Neck Cancer; Induction Combination Chemotherapy of Regionally Advanced Head and Neck Cancer; and Outcome after Complete Remission to Induction Chemotherapy in Head and Neck Cancer

  11. Treatment of complex internal carotid artery aneurysms using radial artery grafts. Surgical technique, perioperative complications, and results in 17 patients

    International Nuclear Information System (INIS)

    Murai, Yasuo; Teramoto, Akira; Mizunari, Takayuki; Kobayashi, Shiro; Kamiyama, Hiroyasu

    2007-01-01

    Complex giant or large internal carotid artery aneurysms present a surgical challenge because limitations and difficulty are encountered with either clipping or endovascular treatment. Our review of previous reports suggests that no current vascular assessment can accurately predict the occurrence of ischemic complications after internal carotid artery ligation. The present study concerns surgical technique, complications, and clinical outcome of radial artery grafting followed by parent artery trapping or proximal occlusion for management of these difficult lesions. Between September 1997 and October 2005, we performed radial artery grafting followed immediately by parent artery occlusion in 17 patients with giant or large complex intracranial carotid aneurysms (3 men, 14 women; mean follow-up duration, 62 months). All patients underwent postoperative digital subtraction angiography to assess graft patency and aneurysm obliteration. All 17 aneurysms were excluded from the cerebral circulation, with all radial artery grafts patent. Among 4 patients with cranial nerve disturbances, dysfunction was temporary in 5; in the others, oculomotor nerve paresis persisted. No perioperative cerebral infarction occurred. Sensory aphasia reflecting cerebral contusions caused by temporal lobe retraction resolved within 2 months, as did hemiparesis from a postoperative epidural hematoma. With appropriate attention to surgical technique, radial artery grafting followed by acute parent artery occlusion is a safe treatment for complex internal carotid artery aneurysms. Graft patency and aneurysm thrombosis were achieved in all patients. Cranial nerve dysfunction (III, VI) caused by altered blood flow from the internal carotid artery after occlusion was the most common complication and typically was temporary. In our experience with these difficult aneurysms, not only clipping but also reconstruction of the internal carotid artery was required, especially for wide-necked symptomatic

  12. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies

    International Nuclear Information System (INIS)

    Chavan, A.; Kirchhoff, T.; Baus, S.; Galanski, M.; Pichlmaier, M.

    2001-01-01

    Purpose. In the endoluminal therapy of abdominal aortic aneurysms, a short proximal aneurysm neck, endoleaks and the large size and stiffness of the introducer systems are responsible for many of the complications and sub-optimal outcomes. The purpose of the present review article is to to suggest strategies to minimize these complications based on the results of experimental studies in animals. Material and methods. After implanting various types of stents across the renal artery origins, the functional and morphological changes in the kidneys and renal vessels were studied by various authors. In order to prevent progressive widening of the proximal aneurysmal neck and graft dislocation, Sonesson et al. performed a laparoscopic banding around the proximal neck in pigs. To study the effects of endoleaks, Marty, Schurink and Pitton carried out pressure measurements in experimental aneurysms with and without endoleaks. Sakaguchi and Pavcnik developed the 'Twin-tube endografts' (TTEG) and the 'Bifurcated drum occluder endografts' (BDOEG) and tested them in dogs. Results. Up to 3 months after suprarenal stent placement, Chavan et al. detected no significant fall in the mean inulin clearance in sheep (140±46 ml/min before, 137±58 ml/min after). Nasim et al. and Malina et al. reported similar observations with respect to renal function. Suprarenal fixation may result in isolated thrombotic occlusions of the renal arteries and microinfarcts in the kidneys. Mean aortic diameters at the level of banding were significantly smaller in the animals with aortic banding as opposed to those in the control group without banding (8 mm vs 11 mm, p=0.004). The banding caused a secure proximal fixation of the stent-graft. Persistent endoleaks resulted in significantly higher intraaneurysmal pressures. Although the TTEG and the BDOEG stent-grafts required smaller sheaths, occlusions were observed in 8% (TTEG) and 60% (BDOEG) of the graft limbs. (orig.) [de

  13. Dynamic contrast-enhanced computed tomography to assess early activity of cetuximab in squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Schmitz, Sandra; Rommel, Denis; Michoux, Nicolas; Lhommel, Renaud; Hanin, François-Xavier; Duprez, Thierry; Machiels, Jean-Pascal

    2015-01-01

    Cetuximab, a monoclonal antibody targeting the Epidermal Growth Factor Receptor (EGFR), has demonstrated activity in various tumor types. Using dynamic contrast-enhanced computed tomography (DCE-CT), we investigated the early activity of cetuximab monotherapy in previously untreated patients with squamous cell carcinoma of the head and neck (SCCHN). Treatment-naïve patients with SCCHN received cetuximab for 2 weeks before curative surgery. Treatment activity was evaluated by DCE-CT at baseline and before surgery. Tumor vascular and interstitial characteristics were evaluated using the Brix two-compartment kinetic model. Modifications of the perfusion parameters (blood flow F p , extravascular space v e , vascular space v p , and transfer constant PS) were assessed between both time points. DCE data were compared to FDG-PET and histopathological examination obtained simultaneously. Plasmatic vascular markers were investigated at different time points. Fourteen patients had evaluable DCE-CT parameters at both time points. A significant increase in the extravascular extracellular space v e accessible to the tracer was observed but no significant differences were found for the other kinetic parameters (F p , v p or PS). Significant correlations were found between DCE parameters and the other two modalities. Plasmatic VEGF, PDGF-BB and IL-8 decreased as early as 2 hours after cetuximab infusion. Early activity of cetuximab on tumor interstitial characteristics was detected by DCE-CT. Modifications of plasmatic vascular markers are not sufficient to confirm anti-angiogenic cetuximab activity in vivo. Further investigation is warranted to determine to what extent DCE-CT parameters are modified and to evaluate whether they are able to predict treatment outcome

  14. Circumstances surrounding aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Schievink, W. I.; Karemaker, J. M.; Hageman, L. M.; van der Werf, D. J.

    1989-01-01

    The circumstances surrounding aneurysmal subarachnoid hemorrhage were investigated in a group of 500 consecutive patients admitted to a neurosurgical center. Subarachnoid hemorrhage occurred during stressful events in 42.8% of the patients, during nonstrenuous activities in 34.4%, and during rest or

  15. Vascular Variations Associated with Intracranial Aneurysms.

    Science.gov (United States)

    Orakdogen, Metin; Emon, Selin Tural; Somay, Hakan; Engin, Taner; Is, Merih; Hakan, Tayfun

    2017-01-01

    To investigate the vascular variations in patients with intracranial aneurysm in circle of Willis. We used the data on 128 consecutive intracranial aneurysm cases. Cerebral angiography images were analyzed retrospectively. Arteries were grouped as anterior cerebral arterial system (ACS), posterior cerebral arterial system (PCS) and middle cerebral arterial system (MCS) for grouping vascular variations. Lateralization, being single/multiple, gender; and also any connection with accompanying aneurysms" number, localization, dimension, whether bleeding/incidental aneurysm has been inspected. Variations were demonstrated in 57.8% of the cases. The most common variation was A1 variation (34.4%). The rate of variations was 36.7%, 24.2% and 10.2% respectively in ACS, PCS and MCS. MCS variations were significantly higher in males. Anterior communicating artery (ACoA) aneurysm observance rates were significantly higher and posterior communicating artery (PCoA) aneurysm and middle cerebral artery (MCA) aneurysm observance rates were significantly lower when compared to "no ACS variation detected" cases. In "PCS variation detected" cases, PCoA aneurysm observance rates and coexistence of multiple variations were significantly higher. The rate of vascular variations in patients with aneurysms was 57.8%. Arterial hypoplasia and aplasia were the most common variations. ACS was the most common region that variations were located in; they were mostly detected on the right side. Coexistence of ACoA aneurysm was higher than PCoA and MCA aneurysms. In the PCS variations group, PCoA aneurysms were the most common aneurysms that accompanying the variation and multiple variations were more common than in the other two groups. The variations in MCS were most common in males.

  16. Onyx HD-500 embolization of intracranial aneurysms: modified technique using continuous balloon inflation under conscious sedation.

    Science.gov (United States)

    Rahme, Ralph; Grande, Andrew; Jimenez, Lincoln; Abruzzo, Todd A; Ringer, Andrew J

    2014-08-01

    The conventional technique of intracranial aneurysm embolization using Onyx HD-500 (ev3 Neurovascular, Irvine, CA, USA) involves repetitive balloon inflation-deflation cycles under general anesthesia. By limiting parent artery occlusion to 5 minutes, this cyclic technique is thought to minimize cerebral ischemia. However, intermittent balloon deflation may lengthen procedure time and allow balloon migration, resulting in intimal injury or Onyx leakage. We report our experience using a modified technique of uninterrupted Onyx injection with continuous balloon occlusion under conscious sedation. All Onyx embolization procedures for unruptured aneurysms performed by the senior author (A.J.R.) between September 2008 and April 2010 were retrospectively reviewed. Demographic, clinical, angiographic, and procedural data were recorded. Twenty-four embolization procedures were performed in 21 patients with 23 aneurysms, including four recurrences. Twenty aneurysms (87%) involved the paraclinoid or proximal supraclinoid internal carotid artery. Size ranged from 2.5 to 24mm and neck diameter from 2 to 8mm. The modified technique was employed in 19 cases. All but one patient (94.4%) tolerated continuous balloon inflation. Complete occlusion was achieved in 20 aneurysms (83.3%) and subtotal occlusion in three (12.5%). Stable angiographic results were seen in 85%, 94%, 94%, and 100% of patients at 6, 12, 24, and 36months, respectively. There were no deaths. Permanent non-disabling neurological morbidity occurred in one patient (4.2%). Minor, transient, and/or angiographic complications were seen in three patients (12.5%), none related to the technique itself. Onyx embolization of unruptured intracranial aneurysms can be safely and effectively performed using continuous balloon inflation under conscious sedation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms

    Directory of Open Access Journals (Sweden)

    Shou-sen WANG

    2012-05-01

    Full Text Available Objective  To investigate the value of virtual reality (VR technique in the surgical planning for anterior circulation aneurysms of Willis circle. Methods  A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study. In preoperative Hunt-Hess scale, grade Ⅰ was designated in 7 patients, grade Ⅱ in 22, grade Ⅲ in 17, grade Ⅳ in 3, grade Ⅴ in 1 patient. Among the aneurysms, 16 were small (≤5mm in diameter, 28 medium (5-15mm, 10 large (15-25mm and 3 giant (≥25mm in size. The thin-slice head scanning data were achieved by 64-slice spiral CT machine. These data was then transferred into Dextroscope image workstation. The virtual imaging system generated clear and vivid virtual images. We compared the findings between simulation surgical operation and actual operation. Results  VR system make the operator felt "personally on the scene" and was able to communicate with the imaging. It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation. All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks. Conclusions  The surgeons is able to be more confident, and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment. The virtual-reality system makes the actual operative procedure more concise, thus it is of positive value in surgery for intracranial aneurysm.

  18. An Unusual Aneurysm of the Main Pulmonary Artery Presenting as Acute Coronary Syndrome

    International Nuclear Information System (INIS)

    Kholeif, Mona A.; El Tahir, Mohamed; Kholeif, Yasser A.; El Watidy, Ahmed

    2006-01-01

    A 70-year old man presented with retrosternal chest pain. His electrocardiogram showed nonspecific T wave changes. Cardiac-specific troponin I (cTnI) was elevated. His condition was managed as acute coronary syndrome, following which he had two minor episodes of hemoptysis. A CT pulmonary angiogram showed no evidence of pulmonary embolism, but a large mass lesion was seen in the mediastinum. Echocardiography and cardiac MRI demonstrated a large solid mass, arising from the right ventricular outflow tract and causing compression of the main pulmonary artery (MPA). The differential diagnosis included pericardial and myocardial tumors and clotted aneurysm of the MPA. At surgery, a clotted aneurysmal sac was identified originating from the MPA and the defect was healed. Aneurysms of the MPA are rare. They most commonly present with dyspnea and chest pain. Compression of surrounding structures produces protean manifestations. A high index of suspicion coupled with imaging modalities establishes the diagnosis. Blunt trauma to the chest, at the time of an accident 4 years previously, may explain this aneurysm. The patient's presentation with chest pain was probably due to compression and/or stretching of surrounding structures. Coronary artery compression simulating acute coronary syndrome has been documented in the literature. The rise in cTnI may have been due to right ventricular strain, as a result of right ventricular outflow obstruction by the aneurysm. This has not been reported previously in the literature. The saccular morphology and narrow neck of the aneurysm predisposed to stagnation leading to clotting of the lumen and healing of the tear, which caused the diagnostic difficulty

  19. Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization : Analysis of Related Factors and Long-Term Outcomes.

    Science.gov (United States)

    Lim, Jeong Wook; Lee, Jeongjun; Cho, Young Dae

    2017-08-08

    Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion. Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression. In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization. Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.

  20. Identification of vortex structures in a cohort of 204 intracranial aneurysms.

    Science.gov (United States)

    Varble, Nicole; Trylesinski, Gabriel; Xiang, Jianping; Snyder, Kenneth; Meng, Hui

    2017-05-01

    An intracranial aneurysm (IA) is a cerebrovascular pathology that can lead to death or disability if ruptured. Abnormal wall shear stress (WSS) has been associated with IA growth and rupture, but little is known about the underlying flow physics related to rupture-prone IAs. Previous studies, based on analysis of a few aneurysms or partial views of three-dimensional vortex structures, suggest that rupture is associated with complex vortical flow inside IAs. To further elucidate the relevance of vortical flow in aneurysm pathophysiology, we studied 204 patient IAs (56 ruptured and 148 unruptured). Using objective quantities to identify three-dimensional vortex structures, we investigated the characteristics associated with aneurysm rupture and if these features correlate with previously proposed WSS and morphological characteristics indicative of IA rupture. Based on the Q -criterion definition of a vortex, we quantified the degree of the aneurysmal region occupied by vortex structures using the volume vortex fraction ( vVF ) and the surface vortex fraction ( sVF ). Computational fluid dynamics simulations showed that the sVF , but not the vVF , discriminated ruptured from unruptured aneurysms. Furthermore, we found that the near-wall vortex structures co-localized with regions of inflow jet breakdown, and significantly correlated to previously proposed haemodynamic and morphologic characteristics of ruptured IAs. © 2017 The Author(s).

  1. The intracranial aneurysm: cost-effective of the aneurysm intra-artery GDC embolization and the aneurysm incarcerated operation

    International Nuclear Information System (INIS)

    Pan Jie; Zhang Shizheng

    2008-01-01

    Objective: To evaluate the cost-effectiveness of the aneurysm intra-artery GDC embolization and the aneurysm clapping of intracranial aneurysm, and to give the instruction for the clinical practice. Methods: A case control study (1 vs. 1) was developed to evaluate the cost in hospital, the cost for return visit and the Quality-adusted Life-Year (QALY) and lifetime costs of the intra-artery GDC embolization and the aneurysm clapping of intraeranial aneurysm, under the matching of the age, sex, living place, the size and place of the aneurysm, and the Hunt and Hess score. Clinically effectiveness dates were derived from the medical records. Cost dates were derived from follow-up by telephones or letters. The correlation analysis was done with the SPSS 13.0. Results: The cost in hospital in AC group was (54 945±16 946)RMBs, which was higher than the ones in AE group (63 768±12 665) RMBs, (t=1.71, P 0.05). Conclusion: The results suggest that the two therapies have no difference in cost effective rate. Considering the physical and mental loss, the aneurysm intra-arteu GDC embolization was better than the aneurysm clapping for the patients with aneurysm that diameter less than 25 mm. (authors)

  2. Difference in aneurysm characteristics between patients with familial and sporadic aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Mensing, Liselore A.; Rinkel, Gabriel J E; Vlak, Monique H M; Van Der Schaaf, Irene C.; Ruigrok, Ynte M.

    2016-01-01

    Object Patients with familial intracranial aneurysms (IA) have a higher risk of rupture than patients with sporadic IA. We compared geometric and morphological risk factors for aneurysmal rupture between patients with familial and sporadic aneurysmal subarachnoid hemorrhage (aSAH) to analyse if

  3. Infected aortic aneurysm and inflammatory aortic aneurysm. In search of an optimal differential diagnosis

    International Nuclear Information System (INIS)

    Ishizaka, Nobukazu; Sohmiya, Koichi; Miyamura, Masatoshi; Umeda, Tatsuya; Tsuji, Motomu; Katsumata, Takahiro; Miyata, Tetsuro

    2012-01-01

    Infected aortic aneurysm and inflammatory aortic aneurysm each account for a minor fraction of the total incidence of aortic aneurysm and are associated with periaortic inflammation. Despite the similarity, infected aortic aneurysm generally shows a more rapid change in clinical condition, leading to a fatal outcome; in addition, delayed diagnosis and misuse of corticosteroid or immunosuppressing drugs may lead to uncontrolled growth of microorganisms. Therefore, it is mandatory that detection of aortic aneurysm is followed by accurate differential diagnosis. In general, infected aortic aneurysm appears usually as a saccular form aneurysm with nodularity, irregular configuration; however, the differential diagnosis may not be easy sometimes for the following reasons: symptoms, such as abdominal and/or back pain and fever, and blood test abnormalities, such as elevated C-reactive protein and enhanced erythrocyte sedimentation rate, are common in infected aortic aneurysm, but they are not found infrequently in inflammatory aortic aneurysm; some inflammatory aortic aneurysms are immunoglobulin (Ig) G4-related, but not all of them; the prevalence of IgG4 positivity in infected aortic aneurysm has not been well investigated; enhanced uptake of 18F-fluorodeoxyglucose (FDG) by 18F-FDG-positron emission tomography may not distinguish between inflammation mediated by autoimmunity and that mediated by microorganism infection. Here we discuss the characteristics of these two forms of aortic aneurysm and the points of which we have to be aware before reaching a final diagnosis. (author)

  4. Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage : a cost-utility analysis

    NARCIS (Netherlands)

    Koffijberg, H.; Buskens, E.; Rinkel, G. J. E.

    Background Aneurysm occlusion after subarachnoid haemorrhage (SAH) aims to improve outcome by reducing the rebleeding risk. With increasing age, overall prognosis decreases, and the complications of aneurysm occlusion increase. The balance of risks for aneurysm occlusion in elderly SAH patients in

  5. Intraobserver and interobserver variability in CT angiography and MR angiography measurements of the size of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hye Jeong [Hallym University College of Medicine, Department of Radiology, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Yoon, Dae Young; Lee, Hyung Jin [Hallym University College of Medicine, Department of Radiology, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of); Kim, Eun Soo [Hallym University College of Medicine, Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do (Korea, Republic of); Jeon, Hong Jun; Lee, Jong Young; Cho, Byung-Moon [Hallym University College of Medicine, Department of Neurosurgery, Kangdong Seong-Sim Hospital, Seoul (Korea, Republic of)

    2017-05-15

    Accurate and reliable measurement of aneurysm size is important for treatment planning. The purpose of this study was to determine intraobserver and interobserver variability of CTA and MRA for measurement of the size of cerebral aneurysms. Thirty patients with 33 unruptured cerebral aneurysms (saccular, >3 mm in their maximal dimension, with no daughter sacs or lobulations) who underwent 256-row multislice CTA, 3-D TOF MRA at 3.0T, and 3D rotational angiography (3DRA) were retrospectively analyzed. Three independent observers measured the neck, height, and width of the aneurysms using the CTA and MRA images. Intraobserver and interobserver variability of CTA and MRA measurements was evaluated using the standardized difference and intraclass correlation coefficient, with 3DRA measurements as the reference standard. In addition, the mean values of the measurements using CTA and MRA were compared with those using 3DRA. The overall intraobserver and interobserver standardized differences in CTA/MRA were 12.83-15.92%/13.48-17.45% and 14.08-17.00%/12.08-17.67%, respectively. The overall intraobserver and interobserver intraclass correlation coefficients of CTA/MRA were 0.88-0.98/0.84-0.96 and 0.86-0.98/0.85-0.95, respectively. Compared to the height and width measurements, measurements of the neck dimensions showed higher intraobserver and interobserver variability. The sizes of the cerebral aneurysms measured by CTA and MRA were 1.13-9.26 and 5.20-9.67% larger than those measured by 3DRA, respectively; however, these differences were not statistically significant. There were no noticeable differences between intraobserver and interobserver variability for both CTA- and MRA-based measurements of the size of cerebral aneurysms. (orig.)

  6. Isolated iliac artery aneurysms with associated hydronephrosis.

    LENUS (Irish Health Repository)

    O'Driscoll, D

    2012-02-03

    An isolated iliac artery aneurysm is where there is aneurysmal dilatation of one or more branches of the iliac system, with no associated dilatation of the aorta. Such aneurysms are rare and comprise 1% of all intra-abdominal aneurysms. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper treatment before possible rupture. We present the clinical and radiological features of three such aneurysms. Ultrasound was the first imaging modality to be performed. Ipsilateral hydronephrosis was demonstrated in each case, this lead to imaging the pelvis and the correct diagnosis. We review the clinical and radiological literature and conclude that the pelvis should be imaged in all cases of unexplained hydronephrosis.

  7. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  8. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ...

  9. Rupture of the neck in nuclear fission

    International Nuclear Information System (INIS)

    Davies, K.T.R.; Managan, R.A.; Nix, J.R.; Sierk, A.J.

    1977-01-01

    We introduce a degree of freedom to describe the rupture of the neck in nuclear fission and calculate the point at which the neck ruptures as the nucleus descends dynamically from its fission saddle point. This is done by mentally slicing the system into two portions at its minimum neck radius and calculating the force required to separate the two portions while keeping their shapes fixed. This force is obtained by differentiating with respect to separation the sum of the Coulomb and nuclear interaction energies between the two portions. For nuclei throughout the Periodic Table we calculate this force along dynamical paths leading from the fission saddle point. The force is initially attractive but becomes repulsive when the neck reaches a critical size. For actinide nuclei the neck radius at which rupture occurs is about 2 fm. This increases the calculated translational kinetic energy of the fission fragments at infinity relative to that calculated for scission occurring at zero neck radius. With the effect of neck rupture taken into account, we calculate and compare with experimental results fission-fragment kinetic energies for two types of nuclear dissipation: ordinary two-body viscosity and one-body dissipation

  10. Angiographic and artefact-free computed tomography imaging of experimental aneurysms embolised with hydrogel filaments

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, Mark R. [Paracelsus Medical University, Department of Radiology and Magnetic Resonance Tomography, Christian Doppler Clinic, Salzburg (Austria); Cruise, Gregory M. [MicroVention Terumo, Aliso Viejo, CA (United States); Killer, Monika [Paracelsus Medical University, Department of Neurology/Neuroscience Institute, Christian Doppler Clinic, Salzburg (Austria)

    2010-04-15

    We compared experimental rabbit carotid bifurcation aneurysms embolised with platinum coils or hydrogel filaments by using digital subtraction angiography (DSA) and computed tomography angiography (CTA). Embolisation was performed using platinum coils (n = 2), hydrogel filaments loaded with iodine (n = 3) and hydrogel filaments loaded with barium sulphate (n = 3). In one case, a stent was deployed in the parent vessel to determine the effect of hydrogel filaments on stent visualisation. DSA evaluations occurred immediately post-treatment. CTA evaluations occurred at 0-13 weeks post-treatment. The DSA and CTA images were evaluated for the lack of artefacts and the visibilities of the embolic mass, individual coils and residual flow in the aneurysm sac and neck. The DSA results were largely concordant among the three groups. The embolic masses were readily evident with some individual coils being distinguished. In the aneurysms embolised with hydrogel filaments, visualisation of the individual coils, residual flow and stent with minor or no artefacts was possible using CTA. On the other hand, the beam hardening artefacts precluded analysis of aneurysms embolised with platinum coils. CTA-compatible embolic devices could have wide applications in diverse locations throughout the vasculature, particularly in combination with stents or stent grafts. (orig.)

  11. Morphological characteristics associated with rupture risk of multiple intracranial aneurysms.

    Science.gov (United States)

    Wang, Guang-Xian; Liu, Lan-Lan; Wen, Li; Cao, Yun-Xing; Pei, Yu-Chun; Zhang, Dong

    2017-10-01

    To identify the morphological parameters that are related to intracranial aneurysms (IAs) rupture using a case-control model. A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study. Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter (PVD), aspect ratio (AR) and size ratio (SR) were evaluated using CT angiography. Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. IAs located in the internal carotid artery (ICA) was associated with a negative risk of rupture, whereas AR, SR1 (height/PVD) and SR2 (depth/PVD) were associated with increased risk of rupture. When SR was calculated differently, the odds ratio values of these factors were also different. The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively. SR3 (maximum size/PVD) was not associated with IAs rupture. IAs located in the ICA are associated with a negative risk of rupture, while high AR (>1.01), SR1 (>1.48) or SR2 (>1.40) are risk factors for multiple IAs rupture. Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  12. Neck x-ray

    Science.gov (United States)

    X-ray - neck; Cervical spine x-ray; Lateral neck x-ray ... There is low radiation exposure. X-rays are monitored so that the lowest amount of radiation is used to produce the image. Pregnant women and ...

  13. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  14. What You Should Know about Cerebral Aneurysms

    Science.gov (United States)

    ... This should include a discussion with a cerebrovascular neurosurgeon who specializes in surgically clipping aneurysms, a neurosurgeon with endovascular expertise and training, a neurointerventionalist (a ...

  15. Mycotic Aneurysm of the Aortic Arch

    Directory of Open Access Journals (Sweden)

    Ji Hye Seo

    2014-08-01

    Full Text Available A mycotic aneurysm of the thoracic aorta is rare. We report a case of mycotic aneurysm that developed in the aortic arch. An 86-year-old man was admitted with fever and general weakness. Blood culture yielded methicillin-resistant Staphylococcus aureus. Chest X-ray showed an enlarged aortic arch, and computed tomography scan revealed an aneurysm in the aortic arch. The patient was treated only with antibiotics and not surgically. The size of the aneurysm increased rapidly, resulting in bronchial obstruction and superimposed pneumonia. The patient died of respiratory failure.

  16. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms.

    Science.gov (United States)

    Kamide, Tomoya; Tabani, Halima; Safaee, Michael M; Burkhardt, Jan-Karl; Lawton, Michael T

    2018-01-26

    OBJECTIVE While most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms. METHODS Results from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed. RESULTS Despite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0-2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits. CONCLUSIONS The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially

  17. Symptomatic unruptured cerebral aneurysms. Features and surgical outcome

    International Nuclear Information System (INIS)

    Date, Isao

    2010-01-01

    Development of less invasive imaging studies, such as magnetic resonance angiography, has increased the chances that unruptured cerebral aneurysms are found. The rupture risk of 'symptomatic' aneurysms is higher than for 'asymptomatic' aneurysms; so 'symptomatic' aneurysms are more often surgically treated. Many reviews examine 'asymptomatic' unruptured cerebral aneurysms, but few evaluate 'symptomatic' aneurysms. The author has treated many patients with symptomatic unruptured cerebral aneurysms and found that improved cranial nerve signs can be expected if the surgical treatment is performed before the symptoms become irreversible; the critical period is approximately 3 months. It is important to suppress the pulsation of the aneurysms compressing the cranial nerves; both a clipping procedure and endovascular coiling are effective. Cranial nerve signs are more commonly the symptoms of unruptured cerebral aneurysms, but large to giant aneurysms can also be the causes of hemiparesis, hydrocephalus, epilepsy, or even cerebral infarction. This review summarizes the features and surgical outcome of symptomatic unruptured cerebral aneurysms. (author)

  18. Neck injury tolerance under inertial loads in side impacts.

    Science.gov (United States)

    McIntosh, Andrew S; Kallieris, Dimitrios; Frechede, Bertrand

    2007-03-01

    Neck injury remains a major issue in road safety. Current side impact dummies and side impact crashworthiness assessments do not assess the risk of neck injury. These assessments are limited by biofidelity and knowledge regarding neck injury criteria and tolerance levels in side impacts. Side impact tests with PMHS were performed at the Heidelberg University in the 1980s and 1990s to improve primarily the understanding of trunk dynamics, injury mechanisms and criteria. In order to contribute to the definition of human tolerances at neck level, this study presents an analysis of the head/neck biomechanical parameters that were measured in these tests and their relationship to neck injury severity. Data from 15 impact tests were analysed. Head accelerations, and neck forces and moments were calculated from 9-accelerometer array head data, X-rays and anthropometric data. Statistically significant relationships were observed between resultant head acceleration and neck force and neck injury severity. The average resultant head acceleration for AIS 2 neck injuries was 112 g, while resultant neck force was 4925 N and moment 241 Nm. The data compared well to other test data on cadavers and volunteers. It is hoped that the paper will assist in the understanding of neck injuries and the development of tolerance criteria.

  19. Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

    International Nuclear Information System (INIS)

    Preda, L.; Di Maggio, E.M.; La Fianza, A.; Dore, R.; Fulle, I.; Solcia, M.; Campani, R.; Gaetani, P.; Rodriguez y Baena, R.; Cecchini, A.; Infuso, L.

    1998-01-01

    We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 ± 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 ± 0.12 cm vs 1.09 ± 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients. (orig.)

  20. Non-enhanced MR imaging of cerebral aneurysms: 7 Tesla versus 1.5 Tesla.

    Science.gov (United States)

    Wrede, Karsten H; Dammann, Philipp; Mönninghoff, Christoph; Johst, Sören; Maderwald, Stefan; Sandalcioglu, I Erol; Müller, Oliver; Özkan, Neriman; Ladd, Mark E; Forsting, Michael; Schlamann, Marc U; Sure, Ulrich; Umutlu, Lale

    2014-01-01

    To prospectively evaluate 7 Tesla time-of-flight (TOF) magnetic resonance angiography (MRA) in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE) for delineation of unruptured intracranial aneurysms (UIA). Sixteen neurosurgical patients (male n = 5, female n = 11) with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel), presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calculated by kappa coefficient and Lin's concordance correlation coefficient. A total of 20 intracranial aneurysms were detected in 16 patients, with two patients showing multiple aneurysms (n = 2, n = 4). Out of 20 intracranial aneurysms, 14 aneurysms were located in the anterior circulation and 6 aneurysms in the posterior circulation. 7 Tesla MPRAGE imaging was superior over 1.5 and 7 Tesla TOF MRA in the assessment of all considered aneurysm and image quality features (e.g. image quality: mean MPRAGE7T: 5.0; mean TOF7T: 4.3; mean TOF1.5T: 4.3). Ratings for 7 Tesla TOF MRA were equal or higher over 1.5 Tesla TOF MRA for all assessed features except for artifact delineation (mean TOF7T: 4.3; mean TOF1.5T 4.4). Interobserver accordance was good to excellent for most ratings. 7 Tesla MPRAGE imaging demonstrated its superiority in the detection and assessment of UIA as well as overall imaging features, offering excellent interobserver accordance and highest scores for all ratings. Hence, it may bear the potential to serve as a high-quality diagnostic tool for pretherapeutic assessment and

  1. Recent Trends in Neuro-endovascular Treatment for Acute Ischemic Stroke, Cerebral Aneurysms, Carotid Stenosis, and Brain Arteriovenous Malformations.

    Science.gov (United States)

    Matsumaru, Yuji; Ishikawa, Eiichi; Yamamoto, Tetsuya; Matsumura, Akira

    2017-06-15

    The efficacy of mechanical thrombectomy with stent retrievers for emergent large vessel occlusion has been proved by randomized trials. Mechanical thrombectomy is increasingly being adopted in Japan since stent retrievers were first approved in 2014. An urgent clinical task is to offer structured systems of care to provide this treatment in a timely fashion to all patients with emergent large vessel occlusion. Treatment with flow-diverting stents is currently a preferred treatment option worldwide for large and giant unruptured aneurysms. Initial studies reported high rates of complete aneurysm occlusion, even in large and giant aneurysms, without delayed aneurysmal recanalization and/or growth. The Pipeline Embolic Device is a flow diverter recently approved in Japan for the treatment of large and giant wide-neck unruptured aneurysms in the internal carotid artery, from the petrous to superior hypophyseal segments. Carotid artery stenting is the preferred treatment approach for carotid stenosis in Japan, whereas it remains an alternative for carotid endarterectomy in Europe and the United States. Carotid artery stenting with embolic protection and plaque imaging is effective in achieving favorable outcomes. The design and conclusions of a randomized trial of unruptured brain arteriovenous malformations (ARUBA) trial, which compared medical management alone and medical management with interventional therapy in patients with an unruptured arteriovenous brain malformation, are controversial. However, the annual bleeding rate (2.2%) of the medical management group obtained from this study is worthy of consideration when deciding treatment strategy.

  2. Popliteal Artery Aneurysm in Women

    DEFF Research Database (Denmark)

    Ravn, Hans; Pansell-Fawcett, Karin; Björck, Martin

    2017-01-01

    OBJECTIVES: Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women. METHODS: Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry......, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry. RESULTS: 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age...... was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion...

  3. Soft tissue aneurysmal bone cyst

    Energy Technology Data Exchange (ETDEWEB)

    Wang, X.L.; Gielen, J.L.; Delrue, F.; De Schepper, A.M.A. [Department of Radiology, Universitair Ziekenhuis Antwerpen (University of Antwerp), Wilrijkstraat 10, 2650, Edegem (Belgium); Salgado, R. [Department of Pathology, Universitair Ziekenhuis Antwerpen (University of Antwerp), Wilrijkstraat 10, 2650, Edegem (Belgium)

    2004-08-01

    A soft tissue aneurysmal bone cyst located in the right gluteus medius of a 21-year-old man is reported. On conventional radiography, the lesion demonstrated a spherically trabeculated mass with a calcific rim. On CT scan, it showed a well-organized peripheral calcification resembling a myositis ossificans. On MRI, it presented as a multilocular, cystic lesion with fluid-fluid levels. The lesion had no solid components except for intralesional septa. Although findings on imaging and histology were identical to those described in classical aneurysmal bone cyst, diagnosis was delayed because of lack of knowledge of this entity and its resemblance to the more familiar post-traumatic heterotopic ossification (myositis ossificans). (orig.)

  4. Soft tissue aneurysmal bone cyst

    International Nuclear Information System (INIS)

    Wang, X.L.; Gielen, J.L.; Delrue, F.; De Schepper, A.M.A.; Salgado, R.

    2004-01-01

    A soft tissue aneurysmal bone cyst located in the right gluteus medius of a 21-year-old man is reported. On conventional radiography, the lesion demonstrated a spherically trabeculated mass with a calcific rim. On CT scan, it showed a well-organized peripheral calcification resembling a myositis ossificans. On MRI, it presented as a multilocular, cystic lesion with fluid-fluid levels. The lesion had no solid components except for intralesional septa. Although findings on imaging and histology were identical to those described in classical aneurysmal bone cyst, diagnosis was delayed because of lack of knowledge of this entity and its resemblance to the more familiar post-traumatic heterotopic ossification (myositis ossificans). (orig.)

  5. Silent Patent Ductus Arteriosus Aneurysm

    Directory of Open Access Journals (Sweden)

    Aline Medeiros Botta

    2002-09-01

    Full Text Available Ductus arteriosus aneurysm, a rare and potentially fatal condition, has been reported as a complication after surgical ductus arteriosus closure. Its spontaneous appearance as a septic complication, which was common in the presurgical and preantibiotic era, has been rarely reported in the contemporary literature. Persistence of silent ductus arteriosus in healthy children and adults is a frequent condition that currently has an increasing diagnostic possibility due to the availability of more accurate investigative methods, especially echocardiography. We report the case of a 1-year-old child, in whom no previous heart disease was known, who developed a giant aneurysm of the ductus arteriosus during a staphylococcal infection. This complication appeared after craniotomy for emptying an accidental subdural hematoma. This report associates the persistence of ductus arteriosus with a complication considered rare, which has a rapidly fatal evolution.

  6. Transarterial embolization in head and neck lesions

    International Nuclear Information System (INIS)

    Chang, Kee Hyun; Han, Man Chung

    1985-01-01

    The transarterial embolization procedures have been performed in a total of 38 patients with head and neck lesions, including 5 carotid-cavernous fistulas, 1 internal carotid aneurysm, 10 meningiomas, 16 nasopharyngeal angiofibromas, 1 post-traumatic epistaxis and 5 other vascular tumors, over the 18 months-period. Six cases of C-C fistula and ICA aneurysm were treated with the detachable balloon catheter technique. The meningiomas, angiofibromas and all other lesions were embolized with superselection of the branches of the external carotid artery such as the internal maxillary, the middle meningeal, the ascending pharyngeal the facial or other branches, using Berenstein superselective catheters or conventional angiographic catheters. The PVA (polyvinyl alcohol foam) and/or Gelfoam particles were used as embolic materials in these cases. Most of the lesions were successfully embolized with minor transient complications such as pain, headache, vomiting, fever and etc. But in 4 cases occurred the serious complications; one cerebral hemorrhage, two cerebral infarctions, and one acute laryngeal edema. The selection of the embolic materials and the catheters, and the complications are briefly discussed

  7. Transarterial embolization in head and neck lesions

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Kee Hyun; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1985-06-15

    The transarterial embolization procedures have been performed in a total of 38 patients with head and neck lesions, including 5 carotid-cavernous fistulas, 1 internal carotid aneurysm, 10 meningiomas, 16 nasopharyngeal angiofibromas, 1 post-traumatic epistaxis and 5 other vascular tumors, over the 18 months-period. Six cases of C-C fistula and ICA aneurysm were treated with the detachable balloon catheter technique. The meningiomas, angiofibromas and all other lesions were embolized with superselection of the branches of the external carotid artery such as the internal maxillary, the middle meningeal, the ascending pharyngeal the facial or other branches, using Berenstein superselective catheters or conventional angiographic catheters. The PVA (polyvinyl alcohol foam) and/or Gelfoam particles were used as embolic materials in these cases. Most of the lesions were successfully embolized with minor transient complications such as pain, headache, vomiting, fever and etc. But in 4 cases occurred the serious complications; one cerebral hemorrhage, two cerebral infarctions, and one acute laryngeal edema. The selection of the embolic materials and the catheters, and the complications are briefly discussed.

  8. Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

    International Nuclear Information System (INIS)

    Wadd, I.H.; Haroon, A.; Ansari, S.

    2015-01-01

    To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

  9. Non-aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Bashir, Asma; Mikkelsen, Ronni; Sørensen, Leif

    2017-01-01

    Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. M...... adequate with absence of hematoma and vasospasm. In contrast, a follow-up DSA should be mandatory for confirming or excluding vascular pathology in case of nPMSAH in order to prevent rebleeding....

  10. Aneurysm Recurrence Volumetry Is More Sensitive than Visual Evaluation of Aneurysm Recurrences.

    Science.gov (United States)

    Schönfeld, M H; Schlotfeldt, V; Forkert, N D; Goebell, E; Groth, M; Vettorazzi, E; Cho, Y D; Han, M H; Kang, H-S; Fiehler, J

    2016-03-01

    Considerable inter-observer variability in the visual assessment of aneurysm recurrences limits its use as an outcome parameter evaluating new coil generations. The purpose of this study was to compare visual assessment of aneurysm recurrences and aneurysm recurrence volumetry with an example dataset of HydroSoft coils (HSC) versus bare platinum coils (BPC). For this retrospective study, 3-dimensional time-of-flight magnetic resonance angiography datasets acquired 6 and 12 months after endovascular therapy using BPC only or mainly HSC were analyzed. Aneurysm recurrence volumes were visually rated by two observersas well as quantified by subtraction of the datasets after intensity-based rigid registration. A total of 297 aneurysms were analyzed (BPC: 169, HSC: 128). Recurrences were detected by aneurysm recurrence volumetry in 9 of 128 (7.0 %) treated with HSC and in 24 of 169 (14.2 %) treated with BPC (odds ratio: 2.39, 95 % confidence interval: 1.05-5.48; P = 0.039). Aneurysm recurrence volumetry revealed an excellent correlation between observers (Cronbach's alpha = 0.93). In contrast, no significant difference in aneurysm recurrence was found for visual assessment (3.9 % in HSC cases and 4.7 % in BPC cases). Recurrences were observed in aneurysms smaller than the sample median in 10 of 33 (30.3 %) by aneurysm recurrence volumetry and in 1 of 13 (7.7 %) by visual assessment. Aneurysm recurrences were detected more frequently by aneurysm recurrence volumetry when compared with visual assessment. By using aneurysm recurrence volumetry, differences between treatment groups were detected with higher sensitivity and inter-observer validity probably because of the higher detection rate of recurrences in small aneurysms.

  11. MODIFIED USE OF A DYNAMIC BITE OPENER - TREATMENT AND PREVENTION OF TRISMUS IN A CHILD WITH HEAD AND NECK-CANCER - A CASE-REPORT

    NARCIS (Netherlands)

    DIJKSTRA, PU; KROPMANS, TJB; TAMMINGA, RYJ

    1992-01-01

    Trismus may be a complication arising during or after treatment of patients with head and neck cancer. Treatment of trismus is difficult, making prevention very important. To prevent and treat trismus in a patient with a nasopharyngeal tumor, the Contract-Relax-Antagonist-Contract (CRAC) technique

  12. Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

    NARCIS (Netherlands)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    BACKGROUND: Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. METHODS AND

  13. Shared genetic risk factors of intracranial, abdominal, and thoracic aneurysms

    NARCIS (Netherlands)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    Background--Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. Methods and

  14. Familial Abdominal Aortic Aneurysm : Clinical Features and Genetics

    NARCIS (Netherlands)

    K.M. van de Luijtgaarden (Koen)

    2016-01-01

    markdownabstractAbstract Cardiovascular disease is the most important cause of death in the world and encompasses occlusive as well as aneurysmal disease. The most common aneurysm in humans is the abdominal aortic aneurysm (AAA). The question is why the aorta dilates in aneurysmal disease and

  15. Intravascular volume after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Hoff, R.G.

    2009-01-01

    Intravascular volume after aneurysmal subarachnoid hemorrhage A subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm is a devastating disorder with an often poor prognosis. The occurrence of delayed cerebral ischemia (DCI) is one of the most important factors determining outcome in

  16. Coiling of ruptured pericallosal artery aneurysms.

    NARCIS (Netherlands)

    Menovsky, T.; Rooij, W.J.J. van; Sluzewski, M.; Wijnalda, D.

    2002-01-01

    OBJECTIVE: To assess the technical feasibility of treating ruptured pericallosal artery aneurysms with detachable coils and to evaluate the anatomic and clinical results. METHODS: Over a period of 27 months, 12 patients with a ruptured pericallosal artery aneurysm were treated with detachable

  17. The role of inflammation in cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    Ali H Turkmani

    2015-06-01

    Full Text Available The natural history of unruptured intracranial aneurysms (IAs is poorly understood. At present, risk factors for aneurysm rupture are limited to demographics and rudimentary anatomic features of the aneurysm. The first sign of aneurysm destabilization and rupture may be subarachnoid hemorrhage, a potentially devastating brain injury with high morbidity and mortality. An emerging body of literature suggests a complex inflammatory cascade likely promotes aneurysm wall remodeling and progressive ballooning of the arterial wall, ultimately terminating in aneurysm rupture. These events likely begin with hemodynamic, flow-related endothelial injury; the injured endothelium stimulates inflammation, including the recruitment and transmigration of inflammatory cells, particularly macrophages. Various proteases are secreted by the inflammatory infiltrate, resulting in degradation of the extracellular matrix and the structural changes unique to IAs. Detailed understanding of these inflammatory processes may result in (1 early identification of patients at high risk for aneurysm rupture, perhaps via arterial wall imaging, and (2 targeted, noninvasive therapies to treat or even prevent cerebral aneurysms.

  18. Microneurosurgical management of anterior choroid artery aneurysms.

    Science.gov (United States)

    Lehecka, Martin; Dashti, Reza; Laakso, Aki; van Popta, Jouke S; Romani, Rossana; Navratil, Ondrej; Kivipelto, Leena; Kivisaari, Riku; Foroughi, Mansoor; Kokuzawa, Jouji; Lehto, Hanna; Niemelä, Mika; Rinne, Jaakko; Ronkainen, Antti; Koivisto, Timo; Jääskelainen, Juha E; Hernesniemi, Juha

    2010-05-01

    Anterior choroid artery aneurysms (AChAAs) constitute 2%-5% of all intracranial aneurysms. They are usually small, thin walled with one or several arteries originating at their base, and often associated with multiple aneurysms. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of AChAAs. This review, and the whole series on intracranial aneurysms (IAs), are mainly based on the personal microneurosurgical experience of the senior author (J.H.) in two Finnish centers (Helsinki and Kuopio) that serve, without patient selection, the catchment area in Southern and Eastern Finland. These two centers have treated more than 10,000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 patients (28%) had altogether 980 internal carotid artery (ICA) aneurysms, of whom 95 patients had 99 (2%) AChAAs. Ruptured AChAAs, found in 39 patients (41%), with median size of 6 mm (range = 2-19 mm), were associated with intracerebral hematoma (ICH) in only 1 (3%) patient. Multiple aneurysms were seen in 58 (61%) patients. The main difficulty in microneurosurgical management of AChAAs is to preserve flow in the anterior choroid artery originating at the base and often attached to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3 dimensional angioarchitecture and proper orientation during the microsurgical dissection. Copyright © 2010 Elsevier Inc. All rights reserved.

  19. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    International Nuclear Information System (INIS)

    Gonzalez Valverde, F.M.; Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-01-01

    Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture

  20. Aneurysmal bone cyst and other nonneoplastic conditions

    International Nuclear Information System (INIS)

    Dahlin, D.C.; McLeod, R.A.

    1982-01-01

    Aneurysmal bone cyst is a benign proliferative tumefaction of bone. Histologic similarities indicate a kinship among classic aneurysmal bone cysts, essentially 'solid' proliferative lesions in bones; giant cell reparative granulomas of the jaws, at the base of the skull, and in the small bones of the hands and feet; skeletal lesions of hyperparathyroidism; and even pseudosarcomatous myositis ossificans, proliferative myositis, and proliferative fasciitis. (orig.)

  1. Portal circulation aneurysms: two case reviews

    International Nuclear Information System (INIS)

    Perret, W. L.; Silva, A de.; Elzarka, A.; Schelleman, A.

    2007-01-01

    Venous aneurysms of the superior mesenteric vein and portal vein are an uncommon occurrence and often an incidental finding. They can also be associated with hepatocellular disease and portal hypertension. We present CT and ultrasound findings of these entities. The management of venous aneurysms is generally conservative with serial imaging

  2. Idiopathic subvalvular aortic aneurysm masquerading as acute coronary syndrome.

    Science.gov (United States)

    Natarajan, Balaji; Ramanathan, Sundar; Subramaniam, Natarajan; Janardhanan, Rajesh

    2016-09-02

    Subvalvular aneurysms are the least common type of left ventricular (LV) aneurysms and can be fatal. Subaortic LV aneurysms are much rarer than submitral LV aneurysms and mostly reported in infancy. They can be congenital or acquired secondary to infections, cardiac surgery or trauma. Here, we report a unique presentation of a large, idiopathic subaortic aneurysm in an adult masquerading as an acute coronary syndrome. Diagnosis was made with the help of a CT aortography. Aneurysm was surgically resected with good results. This case highlights the clinical presentation and management of subaortic aneurysms, an important differential for congenital aortic malformations. 2016 BMJ Publishing Group Ltd.

  3. Models of experimental saccular aneurysms of carotid arteries in canine

    International Nuclear Information System (INIS)

    Zhang Haixia; Cheng Yingsheng; Li Minghua

    2006-01-01

    Objective: To study the availability by making experimental saccular aneurysm models of carotid arteries in canine similar to human intracranial aneurysms. Methods: Twenty healthy canines with experimental saccular side-wall aneurysms of carotid arteries were created successfully by surgery. Results: Forty experimental saccular side-wall aneurysms of carotid arteries were created successfully with 36 aneurysms and parent arteries maintaining patency with each other and four spontaneously occluded confirmed by angiography. Model successful rate reached 90%. Conclusions: Experimental saccular side-wall aneurysms of carotid arteries in canines were one of best models created for simulating human intracranial aneurysms. (authors)

  4. Endovascular Aneurysm Repair of Acute Occlusion of Abdominal Aortic Aneurysm with Intra-Aneurysmal Dissection.

    Science.gov (United States)

    Terai, Yasuhiko; Mitsuoka, Hiroshi; Nakai, Masanao; Goto, Shinnosuke; Miyano, Yuta; Tsuchiya, Hirokazu; Yamazaki, Fumio

    2015-11-01

    To report a rare case of acute abdominal aortic aneurysm (AAA) occlusion successfully treated by endovascular aneurysm repair (EVAR). An 89-year-old man complained of severe back pain and weakness in the bilateral lower extremities. Although there were neither acute ischemic signs on the brain computed tomography (CT) nor critical leg ischemia, the patient presented progressing weakness in the bilateral lower extremities and decreased sensation in the perianal and saddle area. Contrast-enhanced CT demonstrated an infrarenal AAA, the formation of an ulcer-like lesion in the aneurysmal wall, and the complete occlusion of distal AAA because of the caudal extension of intramural hematoma. Both common iliac arteries were patent because of the development of collateral vessels. The neurologic symptoms were considered to be caused by the occlusion of lumbar radicular arteries. EVAR seemed anatomically feasible, if the occlusion could be crossed by guidewires from both side of the common femoral artery. Wires easily traversed the occlusion, and the stent graft could be smoothly unwrapped and opened. The patient could recover decent iliac arterial flow. The neurovascular deficits recovered within 4 days after the procedure. Although our experience may not be reproduced in all case of AAA occlusion, EVAR warrants consideration to reduce the high mortality rate associated with the classical treatments. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Extracranial internal carotid artery aneurysm: case illustration

    Directory of Open Access Journals (Sweden)

    Zenteno Marco

    2017-12-01

    Full Text Available Extracranial internal carotid artery aneurysms (EICAA are uncommon lesion. These aneurysms can be classified as true or false aneurysms, atherosclerotic, dysplastic, infectious, posttraumatic and iatrogenic aneurysms. The most common presentation is central neurologic dysfunction, either a stroke or a transient ischemic attack. The rupture of these aneurysms can lead to severely impairment and can affect the quality of life of the patients or even may lead to death. Management of these lesions is required in most cases to prevent complications, however there is no treatment guideline or expert consensus for the management. We present a case of an unusual EICAA, associated with kinking of the affected vessel and review the literature.

  6. Computed tomographic diagnosis of pulmonary artery aneurysm

    International Nuclear Information System (INIS)

    Maeno, Kouji; Kontani, Kazuhiro; Ito, Makoto; Sakurai, Noboru; Sawada, Taisei; Fukeda, Yasuhiko; Takata, Shigeo; Ikeda, Takayuki; Hattori, Nobu.

    1986-01-01

    Pulmonary artery aneurysms are rare lesions. Clagett et al reported that one aneurysm of the pulmonary artery may be found in approximately 14,000 necropsies. We have experienced a case of giant pulmonary artery aneurysm confirmed by computed tomography. A 38 year-old man with atrial septal defect admitted to Kanazawa City Hospital. He had been pointed out of a right hilar mass when he was 26 years old. His complaint was bloody sputum and cough. Pulmonary angiography was not useful for the definite diagnosis because of its mural thrombi. Enhanced computed tomography showed a giant pulmonary artery aneurysm with a mural thrombi in its cavity. This shows that enhanced computed tomography is very useful for the diagnosis of a pulmonary artery aneurysm with a mural thrombi in its cavity. (author)

  7. Computed tomographic diagnosis of pulmonary artery aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Maeno, Kouji; Kontani, Kazuhiro; Ito, Makoto; Sakurai, Noboru; Sawada, Taisei; Fukeda, Yasuhiko; Takata, Shigeo; Ikeda, Takayuki; Hattori, Nobu

    1986-05-01

    Pulmonary artery aneurysms are rare lesions. Clagett et al reported that one aneurysm of the pulmonary artery may be found in approximately 14,000 necropsies. We have experienced a case of giant pulmonary artery aneurysm confirmed by computed tomography. A 38 year-old man with atrial septal defect admitted to Kanazawa City Hospital. He had been pointed out of a right hilar mass when he was 26 years old. His complaint was bloody sputum and cough. Pulmonary angiography was not useful for the definite diagnosis because of its mural thrombi. Enhanced computed tomography showed a giant pulmonary artery aneurysm with a mural thrombi in its cavity. This shows that enhanced computed tomography is very useful for the diagnosis of a pulmonary artery aneurysm with a mural thrombi in its cavity.

  8. Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

    2007-10-15

    Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

  9. Long-term follow-up of aneurysms treated electively with woven stent-assisted coiling.

    Science.gov (United States)

    Cheung, Nicholas K; Chiu, Albert Hy; Cheung, Andrew K; Wenderoth, Jason D

    2017-12-15

    Preliminary short-term results for stent-assisted coil embolization (SACE) using woven/braided stents have been promising. However, evidence supporting mid- to long-term efficacy and durability is lacking. To report the long-term results for the durability of elective intracranial aneurysms treated with woven stents. Between May 2012 and May 2015, 98 consecutive patients with 103 aneurysms underwent elective woven SACE across three Australian neurovascular centres. All patients had immediate, 6- and 18-month clinical and radiological follow-up. Radiological assessment was performed with modified Raymond-Roy occlusion scores based on angiography results, while clinical assessment was based on the modified Rankin Scale. Six-month follow-up was available in 100 aneurysms, and an 18-month follow-up in 97 aneurysms. Total occlusion rates of 82% were achieved at inception, 82% at 6 months, and 90% at 18 months. Satisfactory occlusion with small neck remnants was present in 17% at inception, 16% at 6 months, and 9% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Intraprocedural thromboembolic events were recorded in 3% and delayed events in 1% (all in patients taking clopidogrel). Aneurysm recurrence occurred in one patient (1%). Technical complications occurred in 5%. The total complication rate was 10%. Woven SACE is safe, efficacious, and durable at long-term 18-month follow-up, with very low recurrence and re-treatment rates. Preliminary results appear better than those for traditional laser-cut stents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Advances in the imaging of cerebral aneurysm inflammation

    Directory of Open Access Journals (Sweden)

    Michael R Levitt

    2015-06-01

    Full Text Available Cerebral aneurysm formation, growth and rupture are thought to be the result of a complex interaction between cerebrovascular hemodynamics and pathobiology. Recently, new evidence has emerged regarding the role of inflammation in the walls of cerebral aneurysms. Noninvasive methods to characterize the degree of inflammation in aneurysms could enable clinicians to estimate the risk of future aneurysm growth and rupture, influencing treatment. This review examines emerging techniques of imaging inflammatory biomarkers in cerebral aneurysms.

  11. Application of Revasculization Technique in Aneurysm Surgery : Kyorin University Experience

    OpenAIRE

    栗田, 浩樹; 山口, 竜一; 池田, 俊貴; 原田, 洋一; 塩川, 芳昭; Hiroki, KURITA; Ryuichi, YAMAGUCHI; Toshiki, IKEDA; Youichi, HARADA; Yoshiaki, SHIOKAWA; 杏林大学医学部脳神経外科・脳卒中センター; 杏林大学医学部脳神経外科・脳卒中センター; 杏林大学医学部脳神経外科・脳卒中センター; 杏林大学医学部脳神経外科・脳卒中センター; 杏林大学医学部脳神経外科・脳卒中センター

    2008-01-01

    Between February 2004 and September 2005, revasculization technique was used in 10 patients with intracranial aneurysm to obliterate the aneurysm and to prevent ischemic complications. Five high-flow external carotid-internal carotid (EC-IC) bypasses with radial artery graft (EC-RA-M2) followed by proximal IC occlusion/trapping were used to obliterate unruptured IC-cavernous large/giant aneurysms and ruptured IC anterior wall aneurysms. One patient with ruptured VA-union dissecting aneurysm w...

  12. The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil.

    Science.gov (United States)

    Ishida, Wataru; Sato, Masayuki; Amano, Tatsuo; Matsumaru, Yuji

    2016-09-01

    OBJECTIVE The importance of a framing coil (FC)-the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil-is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better

  13. Clinical, morphological, and hemodynamic independent characteristic factors for rupture of posterior communicating artery aneurysms.

    Science.gov (United States)

    Zhang, Ying; Jing, Linkai; Liu, Jian; Li, Chuanhui; Fan, Jixing; Wang, Shengzhang; Li, Haiyun; Yang, Xinjian

    2016-08-01

    To identify clinical, morphological, and hemodynamic independent characteristic factors that discriminate posterior communicating artery (PCoA) aneurysm rupture status. 173 patients with single PCoA aneurysms (108 ruptured, 65 unruptured) between January 2012 and June 2014 were retrospectively collected. Patient-specific models based on their three-dimensional digital subtraction angiography images were constructed and analyzed by a computational fluid dynamic method. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. Two clinical factors (younger age and atherosclerosis), three morphological factors (higher aspect ratio, bifurcation type, and irregular shape), and six hemodynamic factors (lower mean and minimum wall shear stress, higher oscillatory shear index, a greater portion of area under low wall shear stress, unstable and complex flow pattern) were significantly associated with PCoA aneurysm rupture. Independent factors characterizing the rupture status were identified as age (OR 0.956, p=0.015), irregular shape (OR 6.709, pPCoA aneurysm rupture were younger age, irregular shape, and low minimum wall shear stress. This may be useful for guiding risk assessments and subsequent treatment decisions for PCoA aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Cerebral Aneurysm Clipping Surgery Simulation Using Patient-Specific 3D Printing and Silicone Casting.

    Science.gov (United States)

    Ryan, Justin R; Almefty, Kaith K; Nakaji, Peter; Frakes, David H

    2016-04-01

    Neurosurgery simulator development is growing as practitioners recognize the need for improved instructional and rehearsal platforms to improve procedural skills and patient care. In addition, changes in practice patterns have decreased the volume of specific cases, such as aneurysm clippings, which reduces the opportunity for operating room experience. The authors developed a hands-on, dimensionally accurate model for aneurysm clipping using patient-derived anatomic data and three-dimensional (3D) printing. Design of the model focused on reproducibility as well as adaptability to new patient geometry. A modular, reproducible, and patient-derived medical simulacrum was developed for medical learners to practice aneurysmal clipping procedures. Various forms of 3D printing were used to develop a geometrically accurate cranium and vascular tree featuring 9 patient-derived aneurysms. 3D printing in conjunction with elastomeric casting was leveraged to achieve a patient-derived brain model with tactile properties not yet available from commercial 3D printing technology. An educational pilot study was performed to gauge simulation efficacy. Through the novel manufacturing process, a patient-derived simulacrum was developed for neurovascular surgical simulation. A follow-up qualitative study suggests potential to enhance current educational programs; assessments support the efficacy of the simulacrum. The proposed aneurysm clipping simulator has the potential to improve learning experiences in surgical environment. 3D printing and elastomeric casting can produce patient-derived models for a dynamic learning environment that add value to surgical training and preparation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Vascular wall flow-induced forces in a progressively enlarged aneurysm model.

    Science.gov (United States)

    Neofytou, Panagiotis; Tsangaris, Sokrates; Kyriakidis, Michalis

    2008-12-01

    The current study is focused on the numerical investigation of the flow field induced by the unsteady flow in the vicinity of an abdominal aortic aneurysm model. The computational fluid dynamics code used is based on the finite volume method, and it has already been used in various bioflow studies. For modelling the rheological behaviour of blood, the Quemada non-Newtonian model is employed, which is suitable for simulating the two-phase character of blood namely a suspension of blood cells in plasma. For examining its non-Newtonian effects a comparison with a corresponding Newtonian flow is carried out. Furthermore, the investigation is focused on the distribution of the flow-induced forces on the interior wall of the aneurysm and in order to study the development of the distribution with the gradual enlargement of the aneurysm, three different degrees of aneurysm-growth have been assumed. Finally and for examining the effect of the distribution on the aneurysm growth, a comparison is made between the pressure and wall shear-stress distributions at the wall for each growth-degree.

  16. CFD and PIV analysis of hemodynamics in a growing intracranial aneurysm.

    Science.gov (United States)

    Raschi, Marcelo; Mut, Fernando; Byrne, Greg; Putman, Christopher M; Tateshima, Satoshi; Viñuela, Fernando; Tanoue, Tetsuya; Tanishita, Kazuo; Cebral, Juan R

    2012-02-01

    Hemodynamics is thought to be a fundamental factor in the formation, progression, and rupture of cerebral aneurysms. Understanding these mechanisms is important to improve their rupture risk assessment and treatment. In this study, we analyze the blood flow field in a growing cerebral aneurysm using experimental particle image velocimetry (PIV) and computational fluid dynamics (CFD) techniques. Patient-specific models were constructed from longitudinal 3D computed tomography angiography images acquired at 1-y intervals. Physical silicone models were constructed from the computed tomography angiography images using rapid prototyping techniques, and pulsatile flow fields were measured with PIV. Corresponding CFD models were created and run under matching flow conditions. Both flow fields were aligned, interpolated, and compared qualitatively by inspection and quantitatively by defining similarity measures between the PIV and CFD vector fields. Results showed that both flow fields were in good agreement. Specifically, both techniques provided consistent representations of the main intra-aneurysmal flow structures and their change during the geometric evolution of the aneurysm. Despite differences observed mainly in the near wall region, and the inherent limitations of each technique, the information derived is consistent and can be used to study the role of hemodynamics in the natural history of intracranial aneurysms.

  17. Electronic database of arterial aneurysms

    Directory of Open Access Journals (Sweden)

    Fabiano Luiz Erzinger

    2014-12-01

    Full Text Available Background:The creation of an electronic database facilitates the storage of information, as well as streamlines the exchange of data, making easier the exchange of knowledge for future research.Objective:To construct an electronic database containing comprehensive and up-to-date clinical and surgical data on the most common arterial aneurysms, to help advance scientific research.Methods:The most important specialist textbooks and articles found in journals and on internet databases were reviewed in order to define the basic structure of the protocol. Data were computerized using the SINPE© system for integrated electronic protocols and tested in a pilot study.Results:The data entered onto the system was first used to create a Master protocol, organized into a structure of top-level directories covering a large proportion of the content on vascular diseases as follows: patient history; physical examination; supplementary tests and examinations; diagnosis; treatment; and clinical course. By selecting items from the Master protocol, Specific protocols were then created for the 22 arterial sites most often involved by aneurysms. The program provides a method for collection of data on patients including clinical characteristics (patient history and physical examination, supplementary tests and examinations, treatments received and follow-up care after treatment. Any information of interest on these patients that is contained in the protocol can then be used to query the database and select data for studies.Conclusions:It proved possible to construct a database of clinical and surgical data on the arterial aneurysms of greatest interest and, by adapting the data to specific software, the database was integrated into the SINPE© system, thereby providing a standardized method for collection of data on these patients and tools for retrieving this information in an organized manner for use in scientific studies.

  18. The effect of endoleak on intra-aneurysmal pressure after EVE for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Huang Sheng; Jing Zaiping; Mei Zhijun; Lu Qingsheng; Zhao Jun; Zhang Suzhen; Zhao Xin; Cai Lili; Tang Jingdong; Xiong Jiang; Liao Mingfang

    2003-01-01

    Objective: To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm (AAA). Methods: Infrarenal aortic aneurysms were created with bovine jugular vein segments or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results: The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased significantly, and the pressure cure showed approximately linear. Conclusion: The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existence

  19. Rasmussen's Aneurysm: A Forgotten Entity?

    International Nuclear Information System (INIS)

    Keeling, A. N.; Costello, R.; Lee, M. J.

    2008-01-01

    We present the case of a rare entity which is a complication of a disease process that had almost disappeared from the Western World. With the recent resurgence in reported cases of Mycobacterium tuberculosis (TB) in Western communities, it is important to recognize complications and sequelae. A young alcoholic male with confirmed active TB suffered a cardiac arrest following massive haemoptysis. Multidetector computed tomography angiography diagnosed a Rasmussen's aneurysm, confirmed by digital subtraction angiography and then successfully embolized with glue. We outline this rare case and the embolization technique and review previously documented reports

  20. Aneurysm of the membranous septum

    Energy Technology Data Exchange (ETDEWEB)

    Goebel, N; Haller, D; Hinterauer, L; Jenni, R

    1984-02-01

    Amongst 9000 patients on whom angiocardiograms has been carried out, a membranous septum aneurysm (MSA) was found in 47. In nine patients out of 27 the MSA could be demonstrated by sonography. The most common abnormalities accompanying this lesion were disturbances in rhythm and conduction (in 29 patients), ventricular septal defect in 29 and aortic insufficiency in 14. Complications included bacterial endocarditis in five patients (three with aortic insufficiency and two with sepsis lenta), aortic insufficiency (which was not of rheumatic or bacterial origin in three patients with conduction defects) and thirteen patients with abnormalities of cardiac rhythm with small VSDs.

  1. Aneurysm of the membranous septum

    International Nuclear Information System (INIS)

    Goebel, N.; Haller, D.; Hinterauer, L.; Jenni, R.; Zurich Univ.

    1984-01-01

    Amongst 9000 patients on whom angiocardiograms has been carried out, a membranous septum aneurysm (MSA) was found in 47. In nine patients out of 27 the MSA could be demonstrated by sonography. The most common abnormalities accompanying this lesion were disturbances in rhythm and conduction (in 29 patients), ventricular septal defect in 29 and aortic insufficiency in 14. Complications included bacterial endocarditis in five patients (three with aortic insufficiency and two with sepsis lenta), aortic insufficiency (which was not of rheumatic or bacterial origin in three patients with conduction defects) and thirteen patients with abnormalities of cardiac rhythm with small VSDs. (orig.) [de

  2. Complications of endovascular treatment of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  3. de novo'' aneurysms following endovascular procedures

    International Nuclear Information System (INIS)

    Briganti, F.; Cirillo, S.; Caranci, F.; Esposito, F.; Maiuri, F.

    2002-01-01

    Two personal cases of ''de novo'' aneurysms of the anterior communicating artery (ACoA) occurring 9 and 4 years, respectively, after endovascular carotid occlusion are described. A review of the 30 reported cases (including our own two) of ''de novo'' aneurysms after occlusion of the major cerebral vessels has shown some features, including a rather long time interval after the endovascular procedure of up to 20-25 years (average 9.6 years), a preferential ACoA (36.3%) and internal carotid artery-posterior communicating artery (ICA-PCoA) (33.3%) location of the ''de novo'' aneurysms, and a 10% rate of multiple aneurysms. These data are compared with those of the group of reported spontaneous ''de novo'' aneurysms after SAH or previous aneurysm clipping. We agree that the frequency of ''de novo'' aneurysms after major-vessel occlusion (two among ten procedures in our series, or 20%) is higher than commonly reported (0 to 11%). For this reason, we suggest that patients who have been submitted to endovascular major-vessel occlusion be followed up for up to 20-25 years after the procedure, using non-invasive imaging studies such as MR angiography and high-resolution CT angiography. On the other hand, periodic digital angiography has a questionable risk-benefit ratio; it may be used when a ''de novo'' aneurysm is detected or suspected on non-invasive studies. The progressive enlargement of the ACoA after carotid occlusion, as described in our case 1, must be considered a radiological finding of risk for ''de novo'' aneurysm formation. (orig.)

  4. Treatment strategy for ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Davidovic, L

    2014-07-01

    Rupture is the most serious and lethal complication of the abdominal aortic aneurysm. Despite all improvements during the past 50 years, ruptured abdominal aortic aneurysms are still associated with very high mortality. Namely, including patients who die before reaching the hospital, the mortality rate due to abdominal aortic aneurysm rupture is 90%. On the other hand, during the last twenty years, the number of abdominal aortic aneurysms significantly increased. One of the reasons is the fact that in majority of countries the general population is older nowadays. Due to this, the number of degenerative AAA is increasing. This is also the case for patients with abdominal aortic aneurysm rupture. Age must not be the reason of a treatment refusal. Optimal therapeutic option ought to be found. The following article is based on literature analysis including current guidelines but also on my Clinics significant experience. Furthermore, this article show cases options for vascular medicine in undeveloped countries that can not apply endovascular procedures at a sufficient level and to a sufficient extent. At this moment the following is evident. Thirty-day-mortality after repair of ruptured abdominal aortic aneurysms is significantly lower in high-volume hospitals. Due to different reasons all ruptured abdominal aortic aneurysms are not suitable for EVAR. Open repair of ruptured abdominal aortic aneurysm should be performed by experienced open vascular surgeons. This could also be said for the treatment of endovascular complications that require open surgical conversion. There is no ideal procedure for the treatment of AAA. Each has its own advantages and disadvantages, its own limits and complications, as well as indications and contraindications. Future reductions in mortality of ruptured abdominal aortic aneurysms will depend on implementation of population-based screening; on strategies to prevent postoperative organ injury and also on new medical technology

  5. Advances in open microsurgery for cerebral aneurysms.

    Science.gov (United States)

    Davies, Jason M; Lawton, Michael T

    2014-02-01

    Endovascular techniques introduced strong extrinsic forces that provoked reactive changes in aneurysm surgery. Microsurgery has become less invasive, more appealing to patients, lower risk, and efficacious for complex aneurysms, particularly those unfavorable for or failing endovascular therapy. To review specific advances in open microsurgery for aneurysms. A university-based, single-surgeon practice was examined for the use of minimally invasive craniotomies, surgical management of recurrence after coiling, the use of intracranial-intracranial bypass techniques, and cerebrovascular volume-outcome relationships. The mini-pterional, lateral supraorbital, and orbital-pterional craniotomies are minimally invasive alternatives to standard craniotomies. Mini-pterional and lateral supraorbital craniotomies were used in one-fourth of unruptured patients, increasing from 22% to 28%, whereas 15% of patients underwent orbital-pterional craniotomies and trended upward from 11% to 20%. Seventy-four patients were treated for coil recurrences (2.3% of all aneurysms) with direct clip occlusion (77%), clip occlusion after coil extraction (7%), or parent artery occlusion with bypass (16%). Intracranial-intracranial bypass (in situ bypass, reimplantation, reanastomosis, and intracranial grafts) transformed the management of giant aneurysms and made the surgical treatment of posterior inferior cerebellar artery aneurysms competitive with endovascular therapy. Centralization maximized the volume-outcome relationships observed with clipping. Aneurysm microsurgery has embraced minimalism, tailoring the exposure to the patient's anatomy with the smallest possible craniotomy that provides adequate exposure. The development of intracranial-intracranial bypasses is an important advancement that makes microsurgery a competitive option for complex and recurrent aneurysms. Trends toward centralizing aneurysm surgery in tertiary centers optimize results achievable with open microsurgery.

  6. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... Professions Site Index A-Z Head and Neck Cancer Treatment Head and neck cancer overview What are my ... and neck cancer. For updated information on new cancer treatments that are available, you should discuss these issues ...

  7. Nuclear medical diagnostic with ventricular aneurysm

    International Nuclear Information System (INIS)

    Litter, H.

    1987-01-01

    In the diagnostic of ventricular aneurysms myocardial scintigraphy and above all radionuclide ventriculography (RNV) have special importance. Because of the non-invasive method and the as a result safe and easy use even with stress studies, RNV can provide a very valuable aid with aneurysm patients in early diagnosis, evaluation of the operability and as well as in the prognosis. It must be noted, however, that the differentiation of multivascular diseases and sometimes ventricular aneurysms can be difficult and the inclusion of an angiocardiograph as a radiological invasive examination procedure seems fitting. (orig./MG) [de

  8. Current management of inguinal false aneurysms

    DEFF Research Database (Denmark)

    Houlind, Kim; Jepsen, Jørn M; Saicu, Cristian

    2017-01-01

    False aneurysms are formed as a result of bleeding causing a hematoma to compress the surrounding tissue. The majority of false aneurysms presenting to the vascular surgeon are caused by iatrogenic injury to an artery. Although anastomotic failure occurs, a much higher number is caused by bleeding...... vessels. endovascular treatment with coils or covered stent grafts have proven useful in infected ilio-femoral false aneurysms. Open surgical repair may be the best treatment in the setting of imminent rupture, massive haematoma and skin necrosis. We present three patient cases treated with open surgery...

  9. False iliac artery aneurysm following renal transplantation

    DEFF Research Database (Denmark)

    Levi, N; Sønksen, Jens Otto Reimers; Schroeder, T V

    1999-01-01

    We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously....... The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent...

  10. Ressecção de aneurisma venoso em veia jugular externa direita Resection of right external jugular vein aneurysm

    Directory of Open Access Journals (Sweden)

    Eduardo Pereira Savi

    2010-12-01

    Full Text Available O aneurisma venoso é uma anomalia rara, cujo diagnóstico pode ser realizado a partir de exames físicos e complementares. Sua raridade justifica a necessidade de investigação e de publicações de estudos de caso, objetivo maior deste estudo. Relata-se aqui o caso de uma paciente que apresentava um abaulamento cervical anterior assintomático, progressivo e com seis meses de evolução. A paciente foi submetida à cervicotomia anterior, sob anestesia geral, com ressecção do segmento venoso acometido e ligadura da veia jugular externa. Realizado o estudo, verificou-se que aneurismas venosos podem causar tromboflebite, embolia pulmonar ou rotura. Cirurgia profilática, quando oferece baixo risco, é cuidadosamente recomendada para pacientes com aneurismas abdominais e altamente recomendada para aneurismas do sistema venoso profundo dos membros inferiores. Outros aneurismas venosos devem ser tratados cirurgicamente quando sintomáticos, desfigurantes ou se apresentarem aumento progressivo.Venous aneurysms are a rare abnormality, usually found in physical or complementary exams. We report a case of a 43-year old female with an asymptomatic and progressive enlarging mass in the neck. She had no history of trauma or cervical puncture. Vascular ultrasound showed a right jugular veins aneurysm with 1,81 x 1,62 cm of diameter. She was undergone resection and ligation of right external jugular vein, under general anesthesia. Venous aneurysm can cause thrombophlebitis, pulmonary embolism or spontaneous rupture. Prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for most patients with lower extremity deep venous aneurysms. Other venous aneurysms should be excised only if they are symptomatic, enlarging, or disfiguring

  11. Feasibility of magnetic resonance angiography (MRA) follow-up as the primary imaging modality after coiling of intracranial aneurysms

    International Nuclear Information System (INIS)

    Bakker, Nicolaas A.; Metzemaekers, Jan D. M.; Dijk, J. Marc C. van; Mooij, Jan Jakob A.; Groen, Rob J. M.; Westerlaan, Henriette E.; Eshghi, Omid S.

    2010-01-01

    Background: Digital subtraction angiography (DSA) is still regarded as the gold standard for detecting residual flow in treated aneurysms. Recent reports have also shown excellent results from magnetic resonance angiography (MRA) imaging. This is an important observation, since DSA is associated with a risk of medical complications, is time consuming, and is more expensive. Purpose: To determine whether MRA could replace conventional DSA and serve as the primary postinterventional imaging modality in patients with coiled intracranial aneurysms. Material and Methods: We studied a prospectively enrolled cohort of 190 patients treated endovascularly for a first-ruptured and/or unruptured intracranial aneurysm between January 2004 and December 2008. The imaging protocol included a 1.5T time-of-flight (TOF) MRA and a DSA at 3 months (on the same day) and, depending on comparability, a 1.5T TOF-MRA or DSA 1 year after treatment. All images were evaluated by a multidisciplinary panel. Results: In 141/190 patients, both an MRA and DSA were performed after 3-month follow-up. In 2/141 patients (1.4%), (small) neck remnants gave false-negative MRA results. In one patient (0.7%), this led to additional neurosurgical clipping of the aneurysm. In 25/141 patients, future follow-up (>3 months) consisted of DSA because of various reasons. In 24/25 of these patients, primary MRA images alone would invariably have led to additional DSA imaging. Conclusion: The present study shows that 1.5T TOF-MRA is a feasible primary follow-up modality after coiling of intracranial aneurysms. Given our data, we now suggest that, in every patient with a coiled intracranial aneurysm, the first follow-up, 3 months after coiling, should be an MRA study. Only when this MRA is inconclusive (e.g., because of coil artifacts), or in the case of suspicion of recanalization, should DSA be performed additionally

  12. Ex vivo repair of renal artery aneurysm associated with surgical treatment of abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kostić Dušan M.

    2004-01-01

    Full Text Available INTRODUCTION Renal artery aneurysms is relatively uncommon with reported incidence ranges from 0.3% to 1%. However, considering all visceral artery aneurysms the percentage of renal artery aneurysms is relatively high between 15-25%. The distal forms of renal artery aneurysms sometimes require "ex vivo" reconstruction and kidney autotransplantation. CASE REPORT A 75-year-old male presented with the right abdominal and back pain. He suffered from a long history of arterial hypertension and chronic renal failure over the last few months (urea blood = 19.8 mmol/l; creatinine = 198 mmol/l. Duplex ultrasonography showed abdominal aortic aneurysm. Subsequent translumbarangiography revealed juxtarenal abdominal aortic aneurysm associated with distal right renal artery aneurysm. The operation was performed under combined thoracic epidural analgesia and general anesthesia using transperitoneal approach. After the laparotomy, the ascending colon was mobilized and reflected medially followed by Kocher maneuver. The result was visualization of the anterior aspect of the right kidney, the collecting system, ureter as well as the right renal vein and artery with large saccular aneurysm located distally. After mobilization of the renal vessels and careful dissection of the ureter, the kidney was explanted. The operation was continued by two surgical teams. The first team performed abdominal aortic aneurysm resection and reconstruction with bifurcated Dacron graft. The second team performed ex vivo reparation of renal artery aneurysm. All time during the explantation, the kidney was perfused by Collins' solution. The saccular right renal artery aneurysm 4 cm in diameter was located at the kidney hilus at the first bifurcation. Three branches originated from the aneurysm. The aneurysm was resected completely. The longest and widest of three branches arising from the aneurysmal sac was end-to-end anastomized with 6 mm PTFE graft. After this intervention, one of

  13. Congenital neck masses.

    Science.gov (United States)

    Rosa, Peter A; Hirsch, David L; Dierks, Eric J

    2008-08-01

    Congenital neck lesions reflect abnormal embryogenesis in head and neck development. A thorough knowledge of embryology and anatomy is critical in the diagnosis and treatment of these lesions. The appropriate diagnosis of these lesions is necessary to provide appropriate treatment and long-term follow up, because some of these lesions may undergo malignant transformation or be harbingers of malignant disease.

  14. Correlation between the clinical presentation and DSA of intracranial aneurysms

    International Nuclear Information System (INIS)

    Fang Chun; Hua Jia; Chen Kemin; Yin Yan; Ge Xin; Ying Yiping

    2001-01-01

    Objective: To evaluate the correlation between the clinical presentation and cerebral angiographic features of intracranial aneurysms. Methods: The authors retrospectively analyzed the relationship between the size, location and shape of 48 patient's cerebral aneurysms and their clinical presentations. Results: Clinical symptoms of cerebral aneurysms were related with their size, location and shape. Aneurysms in different location or at same location may cause similar symptoms or different symptoms. Rotation DSA is a useful examination supplemented to conventional DSA. Conclusions: The relationship between the location and the presentation of intracranial aneurysms is not specific. Rotation DSA plays important role in showing the characteristics of the cerebral aneurysms

  15. Bilateral giant femoropopliteal artery aneurysms: a case report

    Directory of Open Access Journals (Sweden)

    Perdikides Theodossios P

    2008-04-01

    Full Text Available Abstract Introduction Popliteal artery aneurysms are the most common peripheral arterial aneurysms, and are frequently bilateral. Acute limb ischemia, rupture and compression phenomena can complicate these aneurysms when the diameter exceeds 2 cm. Case Presentation We report an 82-year-old male patient with two giant femoropopliteal aneurysms, 10.5 and 8.5 cm diameters, managed in our institution. Both aneurysms were resected and a polytetrafluoroethylene (PTFE femoropopliteal interposition graft was placed successfully. Management and literature review are discussed. Conclusion We believe this is the first report in the medical literature of bilateral giant femoropopliteal aneurysms.

  16. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Stefanczyk, Ludomir; Elgalal, Marcin, E-mail: telgalal@yahoo.co.uk [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Papiewski, Andrzej [Medical University of Lodz, Department of Gastroenterological Surgery (Poland); Szubert, Wojciech [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Szopinski, Piotr [Institute of Hematology and Transfusion Medicine, Clinic of Vascular Surgery (Poland)

    2013-06-15

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  17. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    International Nuclear Information System (INIS)

    Stefańczyk, Ludomir; Elgalal, Marcin; Papiewski, Andrzej; Szubert, Wojciech; Szopiński, Piotr

    2013-01-01

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  18. Embolization of Brain Aneurysms and Fistulas

    Science.gov (United States)

    ... care physician. top of page What are the benefits vs. risks? Benefits Using detachable coils to close off an aneurysm ... risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in ...

  19. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  20. Traumatic intracranial aneurysm: a case report

    International Nuclear Information System (INIS)

    Kang, Si Won; Chun, Kyung Ah; Baik, Joon Hyun; Shin, Kyung Sub

    1994-01-01

    The occurrence of traumatic aneurysm is rare in head injury, but this complication is important as it is a potentially treatable cause delayed onset of intracranial hemorrhage. Authors report one case of traumatic aneurysm involving A1 and A2 junction of anterior cerebral artery. A-28-year-old man with traffic accident was examined with brain CT and cerebral angiography. 1) Brain CT: Initial scan shows multiple skull fractures involving right frontal bones with subarachnoid hemorrhage and pneumocephalus. Follow-up scan shows intracerebral hemorrhage at bilateral frontal lobes. 2) Cerebral angiography: A traumatic aneurysm which is slowly filling and delayed emptying is noted at the junctional portion of A1 and A2 segment of the anterior cerebral artery. This report demonstrates radiologic findings of traumatic aneurysm at anterior cerebral artery with the brief review of the literatures

  1. MR angiography after coiling of intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion

  2. Hypopituitarism is uncommon after aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Klose, Marianne; Brennum, Jannick; Poulsgaard, Lars

    2010-01-01

    Aneurysmal subarachnoid haemorrhage (SAH) has recently been reported as a common cause of chronic hypopituitarism, and introduction of routine neuroendocrine screening has been advocated. We aimed at estimating the risk of hypopituitarism after SAH using strict criteria including confirmatory...

  3. Training model for cerebral aneurysm clipping

    Directory of Open Access Journals (Sweden)

    Hiroshi Tenjin, M.D., Ph.D.

    2017-12-01

    Full Text Available Clipping of cerebral aneurysms is still an important skill in neurosurgery. We have made a training model for the clipping of cerebral aneurysms. The concepts for the model were 1: training model for beginners, 2: three dimensional manipulation using an operating microscope, 3: the aneurysm model is to be perfused by simulated blood causing premature rupture. The correct relationship between each tissue, and softness of the brain and vessels were characteristics of the model. The skull, brain, arteries, and veins were made using a 3D printer with data from DICOM. The brain and vessels were made from polyvinyl alcohol (PVA. One training course was held and this model was useful for training of cerebral aneurysm surgery for young neurosurgeons.

  4. New screening system for unruptured cerebral aneurysms; Combination of an expert system and DSA examination

    Energy Technology Data Exchange (ETDEWEB)

    Samejima, Hirotsugu; Ushikubo, Yukio; Mizokami, Toru [Toho Univ., Tokyo (Japan). School of Medicine; and others

    1990-08-01

    We have designed a screening system to diagnose unruptured aneurysms, including the use of digital subtraction angiography (DSA). We surveyed 115 patients who had undergone clipping procedures after subarachnoid hemorrhage (SAH) and questioned them with regard to the subjective symptoms. Sixty-eight of 92 patients who returned the questionnaire reported, prior to rupture, headache,eye pain, and neck pain most frequently, and also impairment of extraocular movements, ptosis, visual field defects, and motor and sensory disturbances. Nineteen (47.5%) of 40 patients who had complete pain relief after surgery complained of headache from 1 week to 1 month before SAH. In addition, nine patients (22.5%) complained of headache for several years, and were also pain-free after surgery. For the indication of DSA, we employed an expert system based on fuzzy set theory. Seven groups of parameters are: Group 1, a basic questionnaire concerning age, sex, and past and family histories; Group 2, 15 warning signs selected on the basis of retrospective study; and Groups 3-7, detailed questions concerning each sign. Scoring weights assigned to each condition based on the results of the retrospective study, and threshold values were determined by several neurosurgeons. The certainty factors for intermediate hypotheses were calculated from these weights and threshold values and summed up, from which the conclusion was obtained. Twelve new cases of unruptured cerebral aneurysm were diagnosed using this screening system. This system may improve the ability to diagnose cerebral aneurysms before rupture. (author).

  5. Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

    1987-06-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

  6. Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

    1987-06-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

  7. Evaluation of occurring complications after flow diverter treatment of elastase-induced aneurysm in rabbits using micro-CT and MRI at 9.4 T

    Energy Technology Data Exchange (ETDEWEB)

    Simgen, Andreas; Ley, Desiree; Muehl-Benninghaus, Ruben; Koerner, Heiko; Reith, Wolfgang; Yilmaz, Umut [Saarland University Hospital, Department of Neuroradiology, Homburg, Saar (Germany); Roth, Christian [Clinic Bremen-Mitte, Department of Neuroradiology, Bremen (Germany); Cattaneo, Giorgio Franco Maria [Acandis GmbH, Pforzheim (Germany); Mueller, Andreas [Saarland University Hospital, Department of Experimental Surgery, Homburg, Saar (Germany); Kim, Yoo-Jin [Saarland University Hospital, Department of Pathology, Homburg, Saar (Germany); Scheller, Bruno [Saarland University Hospital, Department of Cardiology, Homburg, Saar (Germany)

    2016-10-15

    Flow diverters are increasingly being used to treat intracranial aneurysms. This study evaluates occurring complications of flow-diverting devices in the treatment of experimental aneurysms, involving the use of micro-CT and small animal MRI at 9.4 T, in correlation to angiographic and histological findings. We previously published two preclinical studies, in which we assessed two different flow diverters in the treatment of elastase-induced aneurysms. Devices have been implanted across the aneurysm neck as well as in the abdominal aorta. From these studies, a total of 65 devices (prototype FD (n = 30) and Derivo embolization device (n = 35)) additionally underwent micro-CT and MRI after angiographic follow-up and before being histologically examined. The different architectures of both devices were precisely comparable due to high-resolution micro-CT imaging. Micro-CT revealed wire fractures in nine cases (30 %) only with the prototype FD. In three cases (10 %), severe wire fractures correlated with an in-stent stenosis due to intimal hyperplasia. Other complications, like distal stent occlusions and post-stent stenosis, were seen in both groups and verified with both imaging techniques. Osseous metaplasia were correlated to calcifications seen with micro-CT. MRI enabled visualization of the position of the implanted devices relative to the aneurysm and revealed incomplete aneurysm neck coverage with the prototype FD in two cases (6.7 %). Micro-CT and 9.4-T MRI are valid to discover and understand occurring complications of flow diverters in the preclinical phase and can serve as evaluation tools to minimize complication rates of endovascular devices in the future. (orig.)

  8. Outcome-based anatomic criteria for defining the hostile aortic neck.

    Science.gov (United States)

    Jordan, William D; Ouriel, Kenneth; Mehta, Manish; Varnagy, David; Moore, William M; Arko, Frank R; Joye, James; de Vries, Jean-Paul P M

    2015-06-01

    There is abundant evidence linking hostile proximal aortic neck anatomy to poor outcome after endovascular aortic aneurysm repair (EVAR), yet the definition of hostile anatomy varies from study to study. This current analysis was undertaken to identify anatomic criteria that are most predictive of success or failure at the aortic neck after EVAR. The study group comprised 221 patients in the Aneurysm Treatment using the Heli-FX Aortic Securement System Global Registry (ANCHOR) clinical trial, a population enriched with patients with challenging aortic neck anatomy and failure of sealing. Imaging protocols were not protocol specified but were performed according to the institution's standard of care. Core laboratory analysis assessed the three-dimensional centerline-reformatted computed tomography scans. Failure at the aortic neck was defined by type Ia endoleak occurring at the time of the initial endograft implantation or during follow-up. Receiver operating characteristic curve analysis was used to assess the value of each anatomic measure in the classification of aortic neck success and failure and to identify optimal thresholds of discrimination. Binary logistic regression was performed after excluding highly intercorrelated variables, creating a final model with significant predictors of outcome after EVAR. Among the 221 patients, 121 (54.8%) remained free of type Ia endoleak and 100 (45.2%) did not. Type Ia endoleaks presented immediately after endograft deployment in 58 (58.0%) or during follow-up in 42 (42.0%). Receiver operating characteristic curve analysis identified 12 variables where the classification of patients with type Ia endoleak was significantly more accurate than chance alone. Increased aortic neck diameter at the lowest renal artery (P = .013) and at 5 mm (P = .008), 10 mm (P = .008), and 15 mm (P = .010) distally; aneurysm sac diameter (P = .001), common iliac artery diameters (right, P = .012; left, P = .032), and a conical (P = .049) neck

  9. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Wang Haofu; Wang Yuwei; Li Jun; Zhao Zonggang; Qi Sen

    2010-01-01

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

  10. Splenic artery aneurysm rupture in pregnancy

    International Nuclear Information System (INIS)

    Khan, H.R.; Low, S.; Selinger, M.; Nelson, N.

    2004-01-01

    Rupture of a splenic artery aneurysm, commonly associated with pregnancy is a rare and catastrophic event. We report here a case of a patient in her second pregnancy who presented with a short history of left hypochondriac and epigastric pain, followed by collapse at 32 weeks gestation. Sudden fetal distress lead to emergency caesarean delivery when splenic artery aneurysm rupture was diagnosed. With timely involvement of multidisciplinary personnel both mother and baby survived and had an uneventful recovery. (author)