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Sample records for basilar aneurysm treated

  1. Oculomotor Paresis and Basilar Aneurysm

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    J Gordon Millichap

    1992-01-01

    The clinical and pathologic findings in a 10 month old girl with congenital heart diseasewho died after rupture of a congenital distal basilar artery aneurysm are reported from the University of Connecticut Health Center, Farmington, CT and the Children’s Hospital of Philadelphia, PA.

  2. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

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    Dehdashti, A.R.; Tribolet, N. de [Department of Neurosurgery, HUG, Geneva (Switzerland); Safran, A.B. [Department of Ophthalmology, HUG, Geneva (Switzerland); Martin, J.B.; Ruefenacht, D.A. [Division of Neuroradiology, HUG, Geneva (Switzerland)

    2002-07-01

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  3. Endovascular treatment for ruptured basilar apex aneurysm

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    Sheng LI

    2011-12-01

    Full Text Available Objective The present study aims to prove the effectiveness and safety of endovascular interventional therapy for ruptured basilar apex aneurysm.Methods The imaging data,methods of endovascular treatment,and clinical results of 12 patients suffering from ruptured basilar apex aneurysms from January 2001 to December 2009 were retrospectively analyzed.The 12 patients were composed of 5 males and 7 females,and their ages ranged from 21 years to 58 years.Results Nine patients suffered from narrow-necked aneurysms,which were directly embolized,and the other three suffered from wide-necked aneurysms,which were embolized using a microstent.Eight aneurysms were completely embolized,and the other four were partly embolized.No rebleeding occurred within the follow-up period of 12 months to 36 months,and all patients recovered well without neurological defects.Conclusions Therefore,endovascular treatment for ruptured basilar apex aneurysm is a semi-invasive,safe,and effective method.

  4. Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm

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    Nakov, Vladimir S.; Spiriev, Toma Y.; Todorov, Ivan T.; Simeonov, Plamen

    2017-01-01

    Background: Basilar tip aneurysms are one of the most complex vascular lesions to treat surgically because of their location, depth of the approach, and close proximity of vital neurovascular structures such as the mesencephalon, cranial nerves, perforating arteries to the thalamus. There are different surgical approaches utilized to reach basilar tip aneurysms, namely, pterional, pretemporal, orbitozygomatic, subtemporal, and anterior petrosectomy. Each of them has its advantages and limitations. Methods: In this paper, we present our personal experience with the use of subtemporal approach. The technique is described in detail including its nuances and potential pitfalls. Results: The subtemporal approach is indicated for basilar tip aneurysms located at the level of the floor of the sella turcica to 1 cm above the dorsum sellae. Conclusion: Subtemporal approach offers good surgical corridor for the management of these complex vascular lesions. PMID:28217394

  5. Transfundal stent placement for treatment of complex basilar tip aneurysm: technical note

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    Vasquez, Ciro; Hubbard, Molly; Jagadeesan, Bharathi Dasan; Tummala, Ramachandra Prasad

    2014-01-01

    We describe a case where a complex unruptured basilar tip aneurysm was treated with a unique method of stent-assisted coil embolization. The aneurysm was considered to have a complex anatomy since both the left posterior cerebral artery and left superior cerebellar artery originated from the dome of the aneurysm. Also, the right posterior cerebral artery was incorporated in the aneurysm neck and needed to be protected prior to coil embolization. This case describes placement of a stent across the span of the aneurysm fundus in order to preserve the two branches arising from it, and the aneurysm dome was coiled without any complication. Using modifications of existing strategies for stent-assisted coil embolization, the aneurysm was treated without any complications and all of the vessels at risk were preserved. PMID:25336546

  6. Basilar artery aneurysm case presented with neck pain

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    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.

  7. Endovascular treatment of basilar tip aneurysms associated with moyamoya disease

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    Arita, K.; Kurisu, K.; Ohba, S.; Shibukawa, M.; Kiura, H.; Sakamoto, S. [Department of Neurosurgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, 734-8551, Hiroshima (Japan); Uozumi, T. [Hibino Hospital, Hiroshima (Japan); Nakahara, T. [Division of Neuroendovascular Treatment, Mazda Hospital, Hiroshima (Japan)

    2003-07-01

    We report the efficacy and safety of endovascular treatment of basilar tip aneurysms (BTA) in five patients with moyamoya disease. The patients underwent intra-aneurysmal embolisation with detachable platinum coils. Three BTA presented with subarachnoid haemorrhage (SAH); the other two were asymptomatic. In four cases, one embolisation procedure produced >95% angiographic obliteration of the aneurysm. In the other patient, 80-90% obliteration was achieved initially, but due to growth of the residual aneurysm, the procedure was repeated 7 months later. Two patients experienced transient oculomotor paresis as a procedure-related complication. Mean follow-up was 43.6{+-}34.0 months (range 8-92 months). One patient died of putaminal haemorrhage unrelated to the aneurysm 15 months after embolisation. The other four had no subsequent SAH and survived without sequelae. Endovascular embolisation using detachable platinum coils proved to be a safe and efficient treatment modality for BTA associated with moyamoya disease. (orig.)

  8. Atherosclerotic Aneurysm of the Basilar Artery and Hydrocephalus. A Case Report

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    Ania Alvarado Borges

    2014-08-01

    Full Text Available Intracranial aneurysms are fairly common. Many of them produce no symptoms, often remaining undiagnosed during life. At autopsy, aneurysms of the basilar artery appear in 2 to 5% of the cases; among them, saccular and congenital aneurysms are more common than atherosclerotic and fusiform aneurysms. A case of atherosclerotic aneurysm of the basilar artery diagnosed at autopsy in an 88-year-old man is presented. This patient had been admitted with a diagnosis of ischemic stroke, intracranial hypertension and hydrocephalus, which led physicians to consider a posterior fossa tumor. This paper aims at presenting the autopsy findings that showed the presence of an atherosclerotic aneurysm of the basilar artery.

  9. Bilateral hypoplasia of the internal carotid arteries with basilar aneurysm

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    Briganti, F.; Tortora, F.; Elefante, A. [Universita di Napoli Federico II, Dipartimento di Scienze Neurologiche, Cattedra di Neuroradiologia, 80131, Napoli (Italy); Maiuri, F. [Universita di Napoli Federico II, Department of Neurological Sciences, Neurosurgery Service, Napoli (Italy)

    2004-10-01

    We report a rare case of bilateral hypoplasia of the internal carotid arteries with an associated aneurysm of the basilar tip, studied by CT angiography, MR angiography and digital angiography. The patient became symptomatic with an episode of loss of consciousness, likely due to reduced blood perfusion. The other 20 reported cases of bilateral carotid hypoplasia (only four of which with an associated aneurysm) are reviewed. The findings of noninvasive procedures (including narrowing of the carotid canals on CT) may lead to a correct diagnosis before angiography is performed; they may also help to differentiate angiographic narrowing of the hypoplastic internal carotids from the string sign often observed in some acquired conditions. (orig.)

  10. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

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    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

  11. [Giant vertebro-basilar aneurysm. Frontal syndrome].

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    Rosa, A; Mizon, J P; Sevestre, H

    1991-01-01

    A 72-year-old man presented with an apparent frontal syndrome. He also had bilateral trigeminal neuralgia, a pyramidal syndrome of all 4 limbs, balance disturbances, a horizontal nystagmus when looking to the left and a right velopalatine paralysis. CT scan with contrast showed a hyperdense rounded lesion in the left cerebello-pontine angle. Cerebral angiography showed this to be a large aneurysm of the end of the vertebral arteries. The patient died suddenly. Autopsy confirmed the site and presence of the aneurysm. Balance disturbances, the pyramidal syndrome and velopalatine paralysis could all be explained by brain stem compression and the bilateral nature of the trigeminal neuralgia by compression of the trigemino-thalamic tract. The apparent frontal syndrome, the authors suggest could have resulted from subacute raised intracranial pressure.

  12. Spontaneous regression of a giant basilar artery aneurysm in a young adult after surgical injury:case report and literature review

    Institute of Scientific and Technical Information of China (English)

    ZHANG He; LI Ming-hua; WANG Chun; LI Yong-dong; XU Tao

    2007-01-01

    A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned.But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later, a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

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

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    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.

  14. Segmental myoclonus and basilar artery giant aneurysm case report

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    J. Pitágoras de Mattos

    1992-12-01

    Full Text Available A 70 years-old man was admitted at our hospital because of unstable angina pectoris. He had essential hypertension and right hemiplegia from a ischemic stroke two years before admission. On neurologic examination, it was found mental disorientation, unstable emotionality, right spastic hemiparesis with right Babinski sign, and segmental myoclonus affecting the superior lip and the palate (palatal nystagmus on the right side. On the CT scan, a giant aneurysm of the basilar artery was detected. We conclude that the segmental myoclonus could be explained by ischemic lesions in the Guillain - Mollaret triangle.

  15. Double-barrel Y-configuration stenting for flow diversion of a giant recurrent basilar apex aneurysm with the pipeline flex embolization device

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    Dale Ding

    2016-01-01

    Full Text Available Giant basilar apex aneurysms are extremely challenging to successfully manage. The Pipeline Flex embolization device (PFED is a new generation flow-diverting stent with a modified delivery system which allows resheathing of the stent after partial deployment. We describe a case of double-barrel Y-configuration stenting of a giant, recurrent basilar apex aneurysm using the PFED. A 73-year-old male was previously treated for an unruptured 11-mm basilar apex aneurysm with stent-assisted coiling using a Neuroform stent. The aneurysm was retreated twice with repeat coiling. After the third recurrence and persistent aneurysm growth into a giant, symptomatic lesion, we decided to proceed with flow diversion. We performed Y-stenting of the basilar bifurcation using three PFEDs, and was recoiled the aneurysm sac. Due to the low porosity of the flow diverters, a side-by-side double-barrel configuration was necessary in the basilar artery. Without the PFED's resheathable capability, it would not have been possible to perform Y-stenting with flow diverters.

  16. Double-barrel Y-configuration Stenting for Flow Diversion of a Giant Recurrent Basilar Apex Aneurysm with the Pipeline Flex Embolization Device.

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    Ding, Dale; Starke, Robert M; McGuinness, Ben; Brew, Stefan

    2016-12-01

    Giant basilar apex aneurysms are extremely challenging to successfully manage. The Pipeline Flex embolization device (PFED) is a new generation flow-diverting stent with a modified delivery system which allows resheathing of the stent after partial deployment. We describe a case of double-barrel Y-configuration stenting of a giant, recurrent basilar apex aneurysm using the PFED. A 73-year-old male was previously treated for an unruptured 11-mm basilar apex aneurysm with stent-assisted coiling using a Neuroform stent. The aneurysm was retreated twice with repeat coiling. After the third recurrence and persistent aneurysm growth into a giant, symptomatic lesion, we decided to proceed with flow diversion. We performed Y-stenting of the basilar bifurcation using three PFEDs, and was recoiled the aneurysm sac. Due to the low porosity of the flow diverters, a side-by-side double-barrel configuration was necessary in the basilar artery. Without the PFED's resheathable capability, it would not have been possible to perform Y-stenting with flow diverters.

  17. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

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    Shi-Qing Mu; Xin-Jian Yang; You-Xiang Li; Chu-Han Jiang; Zhong-Xue Wu

    2015-01-01

    Background:The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging.This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.Methods:We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of lnterventional Neuroradiology of Beijing Tiantan Hospital.Clinical and angiographic data were reviewed and evaluated.Results:All patients were treated by the IT technique.That meant the dissecting artery and aneurysm segments were completed occlusion.After the procedure,the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion.Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months),14 patients had a good recovery.Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA.After the second treatment,the patient died by the ventricular tachycardia.Conclusions:The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms,but it is not necessarily the safest or most definitive treatment modality.The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  18. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

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    Shi-Qing Mu

    2015-01-01

    Full Text Available Background: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT technique. Methods: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  19. Vertebro-basilar junction aneurysms: a single centre experience and meta-analysis of endovascular treatments.

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    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-12-01

    Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option.

  20. Successful treatment of a giant pediatric fusiform basilar trunk aneurysm with surpass flow diverter.

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    Kan, Peter; Mokin, Maxim; Puri, Ajit S; Wakhloo, Ajay K

    2016-06-01

    Fusiform aneurysms present a unique challenge to traditional microsurgical and endovascular treatment because of the lack of a discernible neck and the involvement of parent vessel. Flow diversion has increasingly become the treatment of choice for fusiform aneurysms in the anterior circulation, but its results in the posterior circulation are variable. We report successful treatment of a giant fusiform upper basilar trunk aneurysm with the Surpass flow diverter in an adolescent, and discuss the potential advantages of this emerging technology in the treatment of fusiform posterior circulation aneurysms.

  1. Successful treatment of a giant pediatric fusiform basilar trunk aneurysm with surpass flow diverter.

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    Kan, Peter; Mokin, Maxim; Puri, Ajit S; Wakhloo, Ajay K

    2015-06-03

    Fusiform aneurysms present a unique challenge to traditional microsurgical and endovascular treatment because of the lack of a discernible neck and the involvement of parent vessel. Flow diversion has increasingly become the treatment of choice for fusiform aneurysms in the anterior circulation, but its results in the posterior circulation are variable. We report successful treatment of a giant fusiform upper basilar trunk aneurysm with the Surpass flow diverter in an adolescent, and discuss the potential advantages of this emerging technology in the treatment of fusiform posterior circulation aneurysms.

  2. Computational fluid dynamics evaluation of flow reversal treatment of giant basilar tip aneurysm.

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    Alnæs, Martin Sandve; Mardal, Kent-Andre; Bakke, Søren; Sorteberg, Angelika

    2015-10-01

    Therapeutic parent artery flow reversal is a treatment option for giant, partially thrombosed basilar tip aneurysms. The effectiveness of this treatment has been variable and not yet studied by applying computational fluid dynamics. Computed tomography images and blood flow velocities acquired with transcranial Doppler ultrasonography were obtained prior to and after bilateral endovascular vertebral artery occlusion for a giant basilar tip aneurysm. Patient-specific geometries and velocity waveforms were used in computational fluid dynamics simulations in order to determine the velocity and wall shear stress changes induced by treatment. Therapeutic parent artery flow reversal lead to a dramatic increase in aneurysm inflow and wall shear stress (30 to 170 Pa) resulting in an increase in intra-aneurysmal circulation. The enlargement of the circulated area within the aneurysm led to a re-normalization of the wall shear stress and the aneurysm remained stable for more than 8 years thereafter. Therapeutic parent artery flow reversal can lead to unintended, potentially harmful changes in aneurysm inflow which can be quantified and possibly predicted by applying computational fluid dynamics.

  3. The Challenge of Managing Fusiform Basilar Artery Aneurysms: From Acute Ischemic Stroke to a Massive Subarachnoid Hemorrhage

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    Sofia Bezerra

    2011-02-01

    Full Text Available We present the case of a patient with acute brain stem ischemic stroke who was found to have a fusiform basilar aneurysm with a thrombus within the dilated vessel. Three days after the ischemic stroke, the patient had a massive subarachnoid hemorrhage and died. This case illustrates the difficulties in the acute management of ischemic events in patients with basilar fusiform aneurysms, because the natural history of this disease encompasses both bleeding and thrombosis.

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

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    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.

  5. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

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    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms.

  6. Computational Fluid Dynamics modeling of contrast transport in basilar aneurysms following flow-altering surgeries.

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    Vali, Alireza; Abla, Adib A; Lawton, Michael T; Saloner, David; Rayz, Vitaliy L

    2017-01-04

    In vivo measurement of blood velocity fields and flow descriptors remains challenging due to image artifacts and limited resolution of current imaging methods; however, in vivo imaging data can be used to inform and validate patient-specific computational fluid dynamics (CFD) models. Image-based CFD can be particularly useful for planning surgical interventions in complicated cases such as fusiform aneurysms of the basilar artery, where it is crucial to alter pathological hemodynamics while preserving flow to the distal vasculature. In this study, patient-specific CFD modeling was conducted for two basilar aneurysm patients considered for surgical treatment. In addition to velocity fields, transport of contrast agent was simulated for the preoperative and postoperative conditions using two approaches. The transport of a virtual contrast passively following the flow streamlines was simulated to predict post-surgical flow regions prone to thrombus deposition. In addition, the transport of a mixture of blood with an iodine-based contrast agent was modeled to compare and verify the CFD results with X-ray angiograms. The CFD-predicted patterns of contrast flow were qualitatively compared to in vivo X-ray angiograms acquired before and after the intervention. The results suggest that the mixture modeling approach, accounting for the flow rates and properties of the contrast injection, is in better agreement with the X-ray angiography data. The virtual contrast modeling assessed the residence time based on flow patterns unaffected by the injection procedure, which makes the virtual contrast modeling approach better suited for prediction of thrombus deposition, which is not limited to the peri-procedural state.

  7. Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

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    Akiko Marutani

    2016-01-01

    Conclusion: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding.

  8. 翼点入路手术治疗基底动脉顶端动脉瘤%Surgical treatment for basilar artery apex aneurysm via pterional approach

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    高成; 刘相轸; 陈会荣; 林成海; 李敬文; 赵振环

    2008-01-01

    目的 回顾分析基底动脉顶端动脉瘤的手术方法和疗效.方法 2002年1月至2006年1月手术治疗基底动脉顶端动脉瘤9例,其中男3例,女6例,年龄29~57岁(平均46.6±8.4岁).按照Hunt-Hess分级,Ⅰ级2例,Ⅱ级5例,Ⅲ级2例.全部患者采用翼点入路手术,术后复查脑血管造影,随访2个月-4年(平均19个月).结果 完全夹闭6例,不全夹闭1例,包裹2例.全部病人存活,按照GOS预后分级,Ⅴ级5例,Ⅳ级3例,Ⅲ级1例.结论 掌握手术技巧,熟悉脚间池的区域显微解剖,对具体病人进行个体化设计,是提高基底动脉顶端动脉瘤手术效果的关键.%Objective To review the method and outcome of surgical treatment for basilar artery apex aneurysms. Method Nine patients who suffered basilar artery apex aneurysms were operated from Jan. 2002 to Jan. 2006. Among these patients, 3 was man and 6 was women. The age is from 29 to 57 years and average is 46.6± 8.4. Two is grade Ⅰ, 5 is grade Ⅱ and 2 is grade Ⅲ according to the Hunt-Hess grading scale system. All patients were treated via pterional approach and post-operational DSA was done to evaluate the effect of operation. The period of follow-up was from 2 months to 4 years. Results None of the patients died of operation. Six aneurysms were clipped completely and 1 was clipped incompletely, and 2 was wrapping. According to the GOS scale, 5 patients were Ⅴ, 3 was Ⅳ and 1 was Ⅲ. Conclusions Surgical treatment is an important method for the therapy of the basilar artery apex aneurysms. Excellent surgical technique and familiarity with microanatomy of interpeduncular cistern is demanded for obtaining a good outcome.

  9. Insights on a Giant Aneurysm Treated Endovascularly.

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    Graziano, Francesca; Iacopino, Domenico Gerardo; Ulm, Arthur John

    2016-07-01

    Background Endovascular treatment with stent-assisted Guglielmi detachable coils is an accepted method for treating intracranial giant aneurysms that otherwise would require more invasive or destructive treatment or could not be treated at all. Nevertheless, there is a paucity of information concerning inner postcoiling aneurysmal changes in human subjects over the long term. We report a postmortem analysis of a patient with a giant aneurysm at the vertebrobasilar junction (VBJ) who was treated endovascularly and studied pathologically 24 months after treatment. Materials and Method The head was removed at autopsy and prefixed in a 10% neutral buffered formalin solution. The brain was gently removed from the skull base after cutting the intracranial nerves and vascular structures. The giant VBJ aneurysm and its relationship with the brainstem, cranial nerves, and vessels were captured photographically and analyzed. Afterward, under operating microscope guidance, the vertebrobasilar system with the aneurysm was gently and carefully detached from the brainstem and carefully analyzed. Results No complete fibrous obliteration of the aneurysm lumen could be detected in our case, and no endothelialization had taken place 24 months after treatment. Conclusions Our findings agree with those of previous similar reports. Coiling, in particular in large or giant aneurysms, may be burdened by the risk of coil compaction and recanalization, but it has the advantage of not affecting the flow in the perforating arteries.

  10. Minimally Invasive Treatment of Biventricular Hydrocephalus Caused by a Giant Basilar Apex Aneurysm via a Staged Combination of Endoscopy and Endovascular Embolization: A Case Report.

    Science.gov (United States)

    Setty, Pradeep; Volkov, Andrey; Richards, Boyd; Barrett, Ryan

    2015-01-01

    Biventricular hydrocephalus caused by a Giant Basilar Apex Aneurysm (GBAA) is a rare finding that presents unique and challenging treatment decisions. We report a case of GBAA causing a life-threatening biventricular hydrocephalus in which both the aneurysm and hydrocephalus were given definitive treatment through a staged, minimally invasive approach. An obtunded 82-year-old male was found to have biventricular hydrocephalus caused by an unruptured GBAA obstructing the foramina of Monro. The patient was treated via staged, minimally invasive technique that first involved endoscopic fenestration of the septum pellucidum to create communication between the lateral ventricles. A programmable ventriculo-peritoneal shunt was then placed with a high-pressure setting. The patient was then loaded with dual anti-platelet therapy prior to undergoing endovascular coiling of the GBAA with adjacent stenting of the Posterior Cerebral Artery. He remained on dual anti-platelet therapy and the shunt setting was lowered at the bedside to treat the hydrocephalus. At 6-month follow up, the patient had returned to his cognitive baseline, speaking fluently and appropriately. Biventricular hydrocephalus caused by a GBAA can successfully be treated in a minimally invasive fashion utilizing a combination of endoscopy and endovascular therapy, even when a stent-assisted coiling is needed.

  11. Microsurgical management of posterior circulation aneurysms

    Directory of Open Access Journals (Sweden)

    SHI Xiang-en

    2012-02-01

    Full Text Available Objective To retrospectively analyze effective methods for surgical management of posterior circulation aneurysms. Methods There were 42 patients with posterior circulation aneurysms [26 cases of basilar aneurysm (27 aneurysms, 16 cases of vertebral aneurysm (17 aneurysms]. There were 15 patients underwent bypass surgery [4 external carotid artery-P2 segment of posterior cerebral artery (ECA-P2, 2 internal carotid artery-P2 segment of posterior cerebral artery (ICA-P2, 2 internal maxillary artery-P2 segment of posterior cerebral artery (IMA-P2, 2 intracranial segment of vertebral artery-extracranial segment of vertebral artery, 5 occipital artery-posterior inferior cerebellar artery (OA-PICA] and 27 patients underwent simple surgical clipping. Results Activities of daily life of 37 patients recovered to normal (14 patients with aneurysm on the top of basilar artery, 3 with aneurysm on the trunk of basilar artery, 9 with vertebral aneurysm, 5 with posterior inferior cerebellar artery aneurysm, 4 with aneurysm on the junction of P1-P2 segment of posterior cerebral artery, 1 with superior cerebellar artery, and 1 with anterior inferior cerebellar aneurysm. None of them occurred operation-related neurological dysfunction. The recovery rate was 88.09% . Among the other patients, 1 with aneurysm on the top of basilar artery presented severe signs and symptoms of neurological defect and cannot take care of oneself, 2 patients (1 with aneurysm on the top of basilar artery, 1 with aneurysm on the trunk of basilar artery occurred brain stem hemorrhage after operation, and died at perioperative period, 2 with vertebral aneurysm relapsed and was cured after treatment. Conclusion Posterior circulation aneurysm which is not suitable for surgical clipping can be treated with intra? and extra?cranial vessel bypass. It may avoid the risk of surgical clipping of aneurysm.

  12. Combined extracranial-intracranial bypass surgery with stent-assisted coil embolization for moyamoya disease with a ruptured wide-necked basilar trunk aneurysm: a case report.

    Science.gov (United States)

    Jiang, Hanqiang; Ni, Wei; Lei, Yu; Li, Yanjiang; Gu, Yuxiang

    2015-01-01

    A ruptured wide-necked basilar trunk aneurysm is uncommon in patients with moyamoya disease. The optimal treatment is unclear. We report a safe and beneficial treatment modality for moyamoya disease with aneurysms located in the posterior circulation. A 37-year-old man presenting with subarachnoid hemorrhage was admitted to our hospital. Emergent cerebral angiography demonstrated moyamoya disease associated with a wide-necked basilar trunk aneurysm. We performed bilateral extracranial-intracranial bypass surgeries prior to stent-assisted coil embolization of the aneurysm after the acute phase. No complication occurred and the patient was discharged with no neurological deficit. Follow-up digital subtraction angiography (DSA) performed 6 months after the surgery showed that all the anastomosises were patent and bilateral collateral vascular compensation was fully established with no recanalization of the basilar trunk aneurysm post embolization.We also found that high-flow bypass did not contribute to cerebral revascularization as imagined despite the good patency. Combined extracranial-intracranial bypass surgery with endovascular treatment proved to be an efficient therapeutic modality for moyamoya disease with aneurysms located in the posterior circulation. High-flow bypass surgery was not essential due to the inefficiency and the high risk of postoperative cerebral hyperperfusion syndrome.

  13. Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report.

    Science.gov (United States)

    Nimjee, Shahid M; Smith, Tony P; Kanter, Ronald J; Ames, Warwick; Machovec, Kelly A; Grant, Gerald A; Zomorodi, Ali R

    2015-06-01

    Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.

  14. Delayed rebleeding of a spontaneously thrombosed aneurysm after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Muhammad Omar Chohan

    2014-01-01

    Full Text Available Background: This report provides a rare documentation of spontaneous thrombosis of a ruptured aneurysm followed by delayed recanalization and subsequent rerupture. Case Description: A 47-year-old female presented with spontaneous subarachnoid hemorrhage (SAH. Four aneurysms were identified on CT angiogram including a basilar apex aneurysm, considered source of bleeding. Cerebral angiogram on postbleed day (PBD #1 showed spontaneous thrombosis of basilar apex aneurysm. The patient was discharged to a nursing home on PBD #18 after two subsequent studies showed no recanalization of the basilar aneurysm. The patient returned on PBD #26 with a second episode of spontaneous SAH. The previously thrombosed basilar aneurysm had recanalized and reruptured, which was now treated with coil embolization. Conclusion: We are not aware of a previous report of saccular cerebral aneurysm documenting spontaneous thrombosis after SAH and recanalization with second hemorrhage. This occurrence presents a dilemma regarding the timing and frequency of subsequent cerebrovascular imaging and treatment.

  15. Locked-in syndrome in a patient with acute obstructive hydrocephalus, caused by large unruptured aneurysm of the basilar artery (BA).

    Science.gov (United States)

    Kolić, Zlatko; Kukuljan, Melita; Vukas, Duje; Bonifačić, David; Vrbanec, Kristina; Franić, Ivana Karla

    2016-09-15

    We describe a case of acute obstructive hydrocephalus as a consequence of compression of the brainstem by a large aneurysm of the basilar artery (BA) in a 62-year-old male. After the insertion of the ventriculoperitoneal shunt (VPS), we encountered the "locked-in syndrome" clinical condition. "Locked-in syndrome" is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.

  16. The ELANA technique : Constructing a high flow bypass using a non-occlusive anastomosis on the ICA and a conventional anastomosis on the SCA in the treatment of a fusiform giant basilar trunk aneurysm

    NARCIS (Netherlands)

    Streefkerk, HJN; Wolfs, JFC; Sorteberg, W; Sorteberg, AG; Tulleken, CAF

    2004-01-01

    A patient with a partially thrombosed fusiform giant basilar trunk aneurysm presented with devastating headache and symptoms of progressive brain stem compression. Having an aneurysm inaccessible for endovascular treatment, and after failing a vertebral artery balloon occlusion test, he was offered

  17. 血管内栓塞治疗基底动脉顶端动脉瘤%Endovascular Embolization of Basilar Artery Apex Aneurysms

    Institute of Scientific and Technical Information of China (English)

    阮玉山; 卢桂花; 罗昱; 谭源福; 张超元; 肖绍文

    2011-01-01

    Objective To evaluate the therapeutic effect of endovascular embolization for basilar artery apex aneurysms.Methods A retrospective analysis was performed on 17 patients with posterior circulation aneurysms who underwent endovascular embolization between July 2000 and December 2010. In the patients, 6 cases received the treatment in 2 days after acute bleeding stage, 11 cases were treated at 3 to 10 days post-hemorrhage. Three cases with wide necked intracranial aneurysm received the interventional therapy by self expanding stent (Neuroform) and separable detachable coil. The separable detachable coils were occluded in the aneurysms in 14 cases. Glasgow outcome scale (GOS) was conducted to evaluate the outcomes afterwards. Results Complete embolization ( 100% ) was achieved in 10 cases, 3 aneurysms were 95% embolized, and 3 were 90% embolized. Perforation during embolization occurred in one patient who died in the next day. No re-bleeding case but 2 cases of recurrence were found during a follow-up of 6 -36 months (mean, 15 months) post-embolization. According to GOS, good outcome was achieved in 12 cases, mild disability ( being able to look after themselves in daily life) in 3, and severe disability in 1. Conclusion Endovascular embolization is a minimally invasive, relatively safe and effective method for posterior circulation aneurysms.%目的 评价血管内栓塞治疗基底动脉顶端动脉瘤的疗效.方法 回顾性分析2000年7月~2010年12月血管内栓塞治疗17例基底动脉顶端动脉瘤的临床资料.6例在出血2天内、11例在出血3~10天内进行血管内栓塞治疗.应用Neuroform支架辅助弹簧圈栓塞宽颈动脉瘤3例,弹簧圈栓塞14例.结果 17例中成功栓塞16例,其中10例100%栓塞,3例95%栓塞,3例90%栓塞,术中动脉瘤破裂1例(弹簧罔栓塞,次日死亡).出院时格拉斯哥预后评分(GOS),恢复良好12例;中度病残,但生活能自理3例;重度病残,生活不能自理1例.16例随访6

  18. A case of transient hypothermia after trans-lamina terminalis and third ventricle clipping of an extremely high-position basilar tip aneurysm

    Directory of Open Access Journals (Sweden)

    Toshikazu Hidaka

    2015-03-01

    Full Text Available Reports on the trans-lamina terminalis and trans-third ventricular approach are rare. The risk associated with this approach is unknown. After an unsuccessful endovascular surgery, we performed direct surgical clipping via the third ventricle on a 78-year-old woman presenting with an extremely high-positioned, ruptured basilar tip aneurysm. She experienced transient hypothermia for 5 days, and it was considered that this was due to hypothalamic dysfunction. It is necessary to recognize that there is the potential for hypothermia after surgery via the lamina terminalis and third ventricle, even though the mechanisms of hypothalamic thermoregulation are still unclear.

  19. 不同结构支架植入蜿蜒型颅内动脉瘤的仿真研究%Simulation of Intervention for Basilar Sinuous Aneurysms with Different Structural Stent

    Institute of Scientific and Technical Information of China (English)

    乔爱科; 顾兆勇; 孟宪龙; 付文宇

    2011-01-01

    Endovascular stents with different stent shapes or wire cross-section shapes have different effects on the hemodynamics of basilar aneurysm. To quantitatively understand the difference, computational fluid dynamics simulation were performed to investigate the hemodynamics of basilar sinuous aneurysms treated with four types of virtual mesh stents with different porosities and different wire cross-section shapes. Results show that the triangle stent with a lower porosity has more superiority than other stents in weakening the impact of blood to the aneurismal wall and decreasing the local high pressure and wall shear stress. The flow resistance of the new stent with a triangle cross-section is different when blood flows in and out of the aneurismal sac, which brings about different hemodynamics in aneurusms after the stent intervention. The stent with a triangle section is more suitable for sinuous basilar aneurysms comparatively. Those results can provide some theoretically guide the structural design of stents.%为了探讨不同结构的血管内支架对颅内复杂动脉瘤的血液动力学特性的影响,针对同一蜿蜒形颅内动脉瘤结构,构建了4种不同的裸支架(截面形状和孔隙率不同),分别植入动脉瘤的有限元模型,进行流体动力学仿真计算,获得了一些血流动力学的定量信息.4种模型中,无论是在减小血流对动脉瘤远端瘤壁冲击,还是在局部高压力的降低以及减小动脉瘤壁面切应力等方面,孔隙率较低的三角形截面的网格支架的效果均优于其他3种模型支架的效果.设计采用的三角形截面支架由于血液流入和流出时的流阻不同,导致该支架植人动脉瘤后对瘤腔血流的影响不同,从而产生了动脉瘤腔内的血流动力学差异.这可以为支架结构设计提供一些理论指导意义.

  20. Surgical management of intracranial aneurysms previously treated with endovascular therapy

    Directory of Open Access Journals (Sweden)

    Kumar Rajiv

    2010-01-01

    Full Text Available Endovascular treatment with coils of cerebral aneurysm is being increasingly used for definitive treatment. An increasing number of patients are coming for surgical intervention either for recurrences, incomplete coil embolization or its complications. Our objective was to assess the surgical management in such patients. This was a retrospective analysis of the patients who were initially treated with endovascular embolization and later managed surgically with clipping either for unsuccessful coiling, recurrence of aneurysm or post-procedural complication, between 2003 and 2007. Anatomical results were excellent in all five patients, and all the aneurysms were totally excluded from the circulation. All patients had good recovery. None of the patients suffered any major intraoperative or postoperative complication. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy is an emerging challenge, but with proper patient selection and careful planning, this subset of aneurysms can be managed with good results.

  1. 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.)

  2. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting

    NARCIS (Netherlands)

    Schreuder, HWB; Veth, RPH; Pruszczynski, M; Lemmens, JAM; Molenaar, WM; Schraffordt Koops, H.

    1997-01-01

    We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control. complications and functional outcome. The mean follow-up time was 37 months (19 to 154), There was local recurrence in one patient. Two patients developed deep wound infections and o

  3. Ruptured Aortic Aneurysm From Late Type II Endoleak Treated by Transarterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Gunasekaran, Senthil, E-mail: sgunasekaran@lumc.edu [Loyola University Medical Center Chicago (United States); Funaki, Brian, E-mail: bfunaki@radiology.bsd.uchicago.edu; Lorenz, Jonathan, E-mail: jlorenz@radiology.bsd.uchicago.edu [University of Chicago Medical Center (United States)

    2013-02-15

    Endoleak is the most common complication after endovascular aneurysm repair. The most common type of endoleak, a type II endoleak, typically follows a benign course and is only treated when associated with increasing aneurysm size. In this case report, we describe a ruptured abdominal aortic aneurysm due to a late, type II endoleak occurring 10 years after endovascular aneurysm repair that was successfully treated by transarterial embolization.

  4. Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Connor, S.E.J.; Deasy, N.P.; Jeffree, M.A. [Dept. of Neuroradiology, King' s Coll. Hospital, London (United Kingdom); Martin, A.J.; Strong, A.J. [Dept. of Neurosurgery, King' s Coll. Hospital, London (United Kingdom)

    2001-03-01

    A traumatic pseudoaneurysm of the basilar artery with a basilar-cavernous sinus arteriovenous fistula was diagnosed in a 12-year-old girl using CT, MRI and angiography. It was successfully treated by coil embolisation. We speculate on the mode of formation of this rare traumatic lesion. (orig.)

  5. The experience for stent assisted therapy application on complicated basilar artery apex aneurysm%支架辅助技术介入治疗复杂基底动脉顶端动脉瘤的临床应用

    Institute of Scientific and Technical Information of China (English)

    张金峰; 张向艳; 左书浩; 王东; 李建华; 屈浙; 田军; 胡昱红

    2015-01-01

    目的:总结采用支架辅助技术结合弹簧圈介入治疗复杂基底动脉顶端动脉瘤中的经验,并评估其安全性。方法回顾分析27例复杂基底动脉顶端动脉瘤,采用支架技术结合弹簧圈栓塞基底动脉顶端动脉瘤的临床资料。结果27例手术完成,影像学示完全填塞19例,近全填塞7例,疏松填塞1例。手术并发症3例:1例出血,1例载瘤动脉闭塞,1例弹簧圈脱落。死亡2例:1例V级,1例术前2次出血。结论支架辅助技术结合弹簧圈介入治疗复杂基底动脉顶端动脉瘤是一种可选择的、安全的、有效的方法。%Objective To evaluate the security of application with stent assisted therapy combined with axiom detach-able coil on complicated basilar artery apex aneurysm. Method To review and analyze 27 complicated basilar artery apex aneurysm surgery cases, using the application of stent assisted therapy combined with detachable coil deal with the basilar artery apex aneurysm. Result The image of the 27 surgery cases showed that 19 cases were completed tamponed, and 7 cased were nearly completed tamponed, 1 loose tamponed. It also had three operation complica-tions:one hemorrhaged, one parent artery occlusion, one coil detached. 2 death cases: one was V-level, another had secondary hemorrhaged before surgery. Conclusion The application with stent assisted therapy on complicated basilar artery apex aneurysm is selectable, safe and effective.

  6. Late recurrence of a completely occluded large intracranial aneurysm treated with a Tubridge flow diverter.

    Science.gov (United States)

    Zhang, Xiaoxi; Lv, Nan; Wang, Chi; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2017-02-01

    We report a rare case of recurrence of a large intracavernous aneurysm after angiography proved complete occlusion. The aneurysm was treated by a combination of a Tubridge flow diverter and coils, and balloon angioplasty, after flow diverter devices deployment for parent vessel stenosis. Six month angiographic follow-up demonstrated complete occlusion. Unfortunately, obvious aneurysm recurrence was confirmed on 2 year angiographic follow-up. The probable mechanism of recurrence was analyzed.

  7. Rare Complication of non-Treated Abdominal Aortic Aneurysm: Extensive Thrombus in Right Cardiac Chambers

    Science.gov (United States)

    Hotta, Viviane Tiemi; Bluemke, David A.; Staszko, Kamila Fernanda; Pereira, Ana Neri Rodrigues Epitacio; Rochitte, Carlos Eduardo

    2016-01-01

    A 78-year-old patient presented with shortness of breath after falling down. Transthoracic echocardiogram showed an extensive thrombus in the right atrium (RA), extensive thrombosis of the inferior vena cava (IVC), and abdominal aortic aneurysm (AAA). A magnetic resonance confirmed the thrombosis of the RA extending to the IVC, which was apparently fused to the abdominal aortic aneurysm (compression? erosion?). This case illustrates a severe and rare complication of a non-treated AAA. There probably was IVC erosion by the aortic aneurysm, leading to blood stasis and extensive thrombosis of the IVC and right cardiac chambers. PMID:27849260

  8. Abdominal Aortic Aneurysm (AAA)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  9. Giant Intrahepatic Portal Vein Aneurysm: Leave it or Treat it?

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagdeesh S; Nageshwar Reddy, D

    2017-03-01

    Portal vein aneurysm (PVA) is a rare vascular dilatation of the portal vein. It is a rare vascular anomaly representing less than 3% of all visceral aneurysms and is not well understood. Usually, PVA are incidental findings, are asymptomatic, and clinical symptoms are proportionally related to size. Patients present with nonspecific epigastric pain or gastrointestinal bleeding with underlying portal hypertension. PVA may be associated with various complications such as biliary tract compression, portal vein thrombosis/rupture, duodenal compression, gastrointestinal bleeding, and inferior vena cava obstruction. Differential diagnoses of portal vein aneurysms are solid, cystic, and hypervascular abdominal masses, and it is important that the radiologists be aware of their multi-modality appearance; hence, the aim of this article was to provide an overview of the available literature to better simplify various aspects of this rare entity and diagnostic appearance on different modality with available treatment options. In our case, a 55-year-old male patient came to the gastroenterology OPD for further management of pancreatitis with portal hypertension and biliary obstruction with plastic stents in CBD and PD for the same. In this article, we have reported a case of largest intrahepatic portal vein aneurysm and its management by endovascular technique. As per our knowledge, this is the largest intrahepatic portal vein aneurysm and first case where the endovascular technique was used for the treatment of the same.

  10. Fenestrated vertebrobasilar junction aneurysm: diagnostic and therapeutic considerations.

    Science.gov (United States)

    Albanese, Erminia; Russo, Antonino; Ulm, Arthur J

    2009-03-01

    Vertebrobasilar junction (VBJ) aneurysms are uncommon and are often found in association with basilar artery (BA) fenestration. The complex anatomical environment of the VBJ, and the complicated geometry of the fenestration make clipping of these aneurysms difficult. Therefore, endovascular treatment of these aneurysms is now widely accepted. The authors describe the case of a 43-year-old woman with sickle cell anemia. She presented with subarachnoid hemorrhage. Digital subtraction angiography was performed and depicted multiple intracranial aneurysms. The patient had a left superior hypophysial artery aneurysm, a right superior cerebellar artery-posterior cerebral artery aneurysm, and a VBJ aneurysm associated with a fenestration of the BA. The VBJ aneurysm was not identified on the initial angiogram and was only revealed after 3D rotational angiography was performed. The 3D reconstruction was critical to the understanding of the complex geometry associated with the fenestrated BA. The VBJ was reconstructed using a combination endovascular technique. The dominant limb of the fenestration was stented and balloon-assisted coiling was performed, followed by sacrifice of the nondominant vertebral artery using coils and the embolic agent Onyx. Postoperative angiography demonstrated successful occlusion of the aneurysm with reconstruction of the VBJ. To the authors' knowledge, this is the first report of a fenestrated VBJ aneurysm treated with the combination of stenting, balloon remodeling, coiling, and vessel sacrifice. Three-dimensional angiography was critical in making the correct diagnosis of the source of the subarachnoid hemorrhage and with operative planning.

  11. [Abdominal aortic aneurysm treated by endovascular surgery: a case report].

    Science.gov (United States)

    Alconero-Camarero, Ana Rosa; Cobo-Sánchez, José Luis; Casaus-Pérez, María; García-Campo, María Elena; García-Zarrabeitia, María José; Calvo-Diez, Marta; Mirones-Valdeolivas, Luz Elena

    2008-01-01

    An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.

  12. Subarachnoid hemorrhage with blister aneurysms: Endovascular management

    Directory of Open Access Journals (Sweden)

    Swati Dayanand Chinchure

    2014-01-01

    Full Text Available Blister aneurysms of are rare lesions representing a real challenge for diagnosis and management. They typically show small size, hemispherical shape, fragile wall, broad neck, and are arising from non-branching sites of intracranial arteries. Materials and Methods: We retrospectively reviewed all aneurysms treated at our institution. Seventeen patients (6 male, 11 female with 17 blister aneurysms were identified (mean age 53.3, range 41-63 years. Clinical, procedural, angiographic data as well as follow up data were evaluated. Results: All patients presented with aneurysmal subarachnoid hemorrhage. Majority of the blister aneurysms were located in ICA while 1 was located at posterior cerebral artery, 1 at vertebral and 1 involving basilar artery. All patients were treated using single or overlapping stents and if possible additional coiling. There was no intra-operative rupture. Good outcome (mrs 0-2 was seen in 14 patients. Poor clinical outcome (mrs 3-5 was seen in 2 patients due to vasospasm induced ischemic deficits at discharge, both of them improved on follow up (mrs 1 on follow up. There were 3 mortalities, One patient died of rebleeding while other 2 died due to SAH induced complications. Follow-up angiography was available in 16 patients (one patient died before follow up angiogram and revealed complete or near complete aneurysm occlusion in 11, incomplete obliteration in 1 and no change in 2 cases. Two cases showed post-treatment angiographic aneurysm recurrence. Both cases were managed with repeat coiling and overlapping stent placement. Conclusion: Endovascular management using single/overlapping stent and if possible coil placement is technically safe and feasible in blister aneurysms. Overlapping stents lead to better aneurysm occlusion than a single stent. Blister aneurysm in dorso-medial ICA showed higher tendency of continued growth/recurrence, higher incidence of clinical vasospasm and in these cases early angiographic follow

  13. Percutaneous implantation of a unibody endograft to treat non-aneurysmal aortoiliac disease.

    Science.gov (United States)

    Martins Cury, Marcus Vinícius; Rodrigues, Thiago Osawa; Issa, Antônio Augusto Tadeu

    2017-03-01

    This case-series report describes the use of an Endologix AFX(®) stent graft for the treatment of non-aneurysmal aortic disease. Over a period of 26 months, this device was successfully implanted in six patients with aortic bifurcation < 15 mm to treat critical limb ischemia secondary to dissection, ulcer, or coarctation.

  14. A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery.

    Science.gov (United States)

    Lai, Leon T; Morgan, Michael K; Chin, David C W; Snidvongs, Kornkiat; Huang, June X Z; Malek, Joanne; Lam, Matthew; McLachlan, Rohan; Harvey, Richard J

    2013-04-01

    The anterior transclival route to basilar artery aneurysms is not widely performed. The objective of this study was to carry out a feasibility assessment of the transclival approach to basilar aneurysms with advanced endonasal techniques on 11 cadaver heads. Clival dura was exposed from the sella to the foramen magnum between the paraclival segments of the internal carotid arteries (ICA) laterally. An inverted dural "U" flap was reflected inferiorly to expose the basilar artery. The maximal dimensions from operative measurements were recorded. Surgical manoeuvrability of multiple instruments and the proficiency to place proximal and distal vascular clips were evaluated. The mean operative depth (± standard deviation), measured from the anterior choanae to the basilar artery, was 110±6mm. The lateral corridors were limited distally by the medial pterygoids (mean width 21±2mm) and paraclival ICA (mean width 20±2mm). The mean transclival craniectomy dimensions were 19±2mm (width) and 23±4mm (height). Exposure of the basilar-anterior inferior cerebellar artery junction, superior cerebellar artery, and the basilar caput were possible in 100%, 91%, and 64% of instances, respectively. Placements of proximal and distal aneurysm clips were achieved in all instances. Based on our findings, the transclival endoscopic endonasal surgery approach provides excellent visualisation of the basilar artery. Clip application and manoeuvrability of instruments was considered adequate for basilar aneurysm surgery. Surgical skills and instrumentation to control significant haemorrhage can potentially limit the clinical applicability of this technique.

  15. Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients Impressão basilar, malformação de Chiari e siringomielia: estudo retrospecivo de 53 casos operados

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    José Alberto Gonçalves da Silva

    2003-06-01

    Full Text Available The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI, Chiari malformation (CM, and syringomyelia (SM. The patients were divided into two groups. Group I (24 patients underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior- caudal direction, avoiding, in this way, its adherence to the cerebellum.São analisados os resultados obtidos com o tratamento cirúrgico de 53 casos de impressão basilar (IB, malformação de Chiari (MC e siringomielia (SM. Os pacientes foram divididos em dois grupos: no grupo I (24 casos foi realizada a descompressão osteodural, caracterizada por craniectomia ampla occipital inferior, laminectomia variável de C 1 a C 3, abertura da dura-máter em forma de Y, dissecção das aderências aracnóideas das tonsilas cerebelares com o bulbo e medula cervical, abertura ampla do quarto ventrículo e enxerto dural; no grupo II (29 casos foi utilizada a descompressão osteodural-neural, caracterizada pelos mesmos detalhes técnicos empregados no grupo I, acrescidos da

  16. The intervention effect of diammonium glycyrrhizinate on the formation of basilar artery aneurysm in rabbits%甘草酸二铵干预兔基底动脉瘤形成的实验研究

    Institute of Scientific and Technical Information of China (English)

    桂铮; 汪子文; 张鹏飞; 赵文可; 于耀宇

    2016-01-01

    Objective To explore the mechanism and intervention effects of diammonium glycyrrhizinate (DG) on the formation of intracranial aneurysm (IA) in rabbits. Methods Forty New Zealand rabbits were randomly divided into four groups: control group, IA group, normal saline (NS) group and DG group, 10 rabbits for each group. Except for the control group, rabbits in other three groups were operated with bilateral common carotid artery ligation to produce basilar artery aneurysm formation model. DG group was injected intravenously with DG[20 mg/(kg·d)]from the first day to the seventh day after operation, NS group was given same volume of normal saline, while IA group was injected nothing. The expressions of NF-κB and MMP-9 were detected by immunohistochemical staining, whileα-SMA was stained with immunofluorescence. Results The expressions of NF-κB and MMP-9 were significantly higher in IA group and NS group than those of control group, whileα-SMA expression was significantly lower than that of control group (P0.05). The expressions of NF-κB and MMP-9 were significantly lower in DG group than those of IA group and NS group (P<0.05). The expression of α-SMA was significantly higher in DG group than that of IA group and NS group (P<0.05). Conclusion DG can downregulate the expression levels of NF-κB and MMP-9 in intracranial aneurysm, suppress inflammatory in artery wall and reduce the pathological changes and have intervention effect on intracranial aneurysm formation.%目的:探讨甘草酸二铵(DG)干预兔基底动脉瘤发生的作用机制。方法新西兰白兔40只,按照随机数字表法分为对照组、动脉瘤(IA)组、生理盐水(NS)组、DG组,每组10只。其中对照组不做任何处理,其余各组结扎双侧颈总动脉建立基底动脉瘤形成模型。在造模后的第1~7天,IA组不做处理,DG组给予DG[20 mg/(kg·d)]静脉注射,NS组注入等剂量生理盐水。使用免疫组化染色方法检测基

  17. Mechanical design of an intracranial stent for treating cerebral aneurysms.

    Science.gov (United States)

    Shobayashi, Yasuhiro; Tanoue, Tetsuya; Tateshima, Satoshi; Tanishita, Kazuo

    2010-11-01

    Endovascular treatment of cerebral aneurysms using stents has advanced markedly in recent years. Mechanically, a cerebrovascular stent must be very flexible longitudinally and have low radial stiffness. However, no study has examined the stress distribution and deformation of cerebrovascular stents using the finite element method (FEM) and experiments. Stents can have open- and closed-cell structures, and open-cell stents are used clinically in the cerebrovasculature because of their high flexibility. However, the open-cell structure confers a risk of in-stent stenosis due to protrusion of stent struts into the normal parent artery. Therefore, a flexible stent with a closed-cell structure is required. To design a clinically useful, highly flexible, closed-cell stent, one must examine the mechanical properties of the closed-cell structure. In this study, we investigated the relationship between mesh patterns and the mechanical properties of closed-cell stents. Several mesh patterns were designed and their characteristics were studied using numerical simulation. The results showed that the bending stiffness of a closed-cell stent depends on the geometric configuration of the stent cell. It decreases when the stent cell is stretched in the circumferential direction. Mechanical flexibility equal to an open-cell structure was obtained in a closed-cell structure by varying the geometric configuration of the stent cell.

  18. Noninvasive follow-up of GDC-treated saccular aneurysms by MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Weber, W.; Henkes, H.; Nahser, H.C.; Roer, N.; Kuehne, D. [Klinik fuer Radiologie und Neuroradiologie, Alfried Krupp von Bohlen und Halbach Krankenhaus, Essen (Germany); Yousry, T.A. [Abt. fuer Neuroradiologie, Klinikum Grosshadern, Muenchen (Germany); Felber, S.R. [Dept. of Radiology II and Department of Magnetic Resonance, Univ. Innsbruck (Austria)

    2001-09-01

    The aim of this study was to determine sensitivity and specificity of magnetic resonance angiography (MRA) for the assessment of durable occlusion of intracranial aneurysms with Guglielmi detachable coils (GDC) and to point out the influence of MRA results in re-intervention strategies. Forty-five patients with 54 aneurysms that were previously treated by endovascular occlusion with GDC were selected for this study. All patients underwent digital subtraction angiography (DSA) and MRA examinations on the same day. The time-of-flight MRA studies were performed on a 1-T scanner. The MRA images were first read by radiologists who were not aware of the DSA results. In a second consensus reading by the neuroradiologists who had performed all interventional procedures of this series, the decision was made as to whether re-treatment was necessary. The distribution of aneurysm sizes, configurations and treatment results were sufficient for an unbiased evaluation. The first blinded evaluation revealed a sensitivity of 71% and a specificity of 95% for MRA assessment of aneurysm reperfusion. In the second consensus reading, the sensitivity increased to 92% and the specificity was 98%. The blinded reading indicates that MRA is a useful adjunct to DSA for the assessment of durable results after endovascular treatment of intracranial aneurysms. In the consensus reading it became obvious that sensitivity and specificity of MRA can be increased to 92 and 98%, respectively, if the results were evaluated by experienced neuroradiologists, including prior knowledge of all other examinations. We have already increased the follow-up intervals for DSA and use MRA intermittently, based on these results. (orig.)

  19. 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.

  20. 高压氧治疗基底型偏头痛的临床研究%Clinical research on treating basilar migraine with hyperbaric oxygen

    Institute of Scientific and Technical Information of China (English)

    谷松; 过伟峰

    2014-01-01

    Objective:To observe the curative effect and discuss the mechanism of hyperbaric oxygen on treating basilar migraine. Methods: 65 patients with basilar migraine were randomly divided into the treatment group (n=33) and the control group (n=32) by random number table. Patients in the treatment group were treated by sealed pressure cabin, 0.2 MPa(2.0ATA)for 65min, and mask absorbing pure oxygen for 30min×2, absorbing air for 5min and depressurization for 25min, once daily. Patients in the control group were given orally 10mg flunarizine hydrochloride before sleeping. The curative effects were compared for 10 days, a course of treatment. Results:I Before treatment, there was no significant difference in VAS, VRS and non-painful duration between the two groups (P>0.05); After treatment, VAS and VRS reduced obviously in the two groups (P0.05);After treatment, Vs, Vm and Vd increased in both, and it was clearer in the treatment group (P0.05),治疗后两组 VAS、VRS 均较治疗前明显降低(P0.05);治疗后两组BA的Vs、Vm、Vd均有增加,并且治疗组(P<0.01)改善的程度比对照组(P<0.05)明显,治疗组 PI 明显下降;两组治疗后比较,差异具有明显统计学意义(P<0.01)。结论:两组治疗方法均能够显著改善基底型偏头痛患者发作时头痛程度及发作频度,改善患者基底动脉的血流速度及搏动指数,且高压氧治疗优于药物治疗。高压氧治疗基底型偏头痛有效,其机理之一可能为高压氧能够抑制炎性介质及血小板释放,增加基底动脉供血。

  1. Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

    Energy Technology Data Exchange (ETDEWEB)

    Carneiro, Angelo; Byrne, James V. [ohn Radcliffe Hospital, Oxford Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, Oxford (United Kingdom); Rane, Neil; Kueker, Wilhelm; Cellerini, Martino; Corkill, Rufus [John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom)

    2014-01-15

    This study assessed volume changes of unruptured large and giant aneurysms (greatest diameter >20 mm) after treatment with flow diverter (FD) stents. Clinical audit of the cases treated in a single institution, over a 5-year period. Demographic and clinical data were retrospectively collected from the hospital records. Aneurysm volumes were measured by manual outlining at sequential slices using computerised tomography (CT) or magnetic resonance (MR) angiography data. The audit included eight patients (seven females) with eight aneurysms. Four aneurysms involved the cavernous segment of the internal carotid artery (ICA), three the supraclinoid ICA and one the basilar artery. Seven patients presented with signs and symptoms of mass effect and one with seizures. All but one aneurysm was treated with a single FD stent; six aneurysms were also coiled (either before or simultaneously with FD placement). Minimum follow-up time was 6 months (mean 20 months). At follow-up, three aneurysms decreased in size, three were unchanged and two increased. Both aneurysms that increased in size showed persistent endosaccular flow at follow-up MR; in one case, failure was attributed to suboptimal position of the stent; in the other case, it was attributed to persistence of a side branch originating from the aneurysm (similar to the endoleak phenomenon of aortic aneurysms). At follow-up, five aneurysms were completely occluded; none of these increased in volume. Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause. (orig.)

  2. Surgical treatment for ruptured anterior inferior cerebellar artery aneurysms

    Directory of Open Access Journals (Sweden)

    TONG Xiao-guang

    2013-03-01

    Full Text Available Background Anterior inferior cerebellar artery (AICA aneurysm is an extremely raretumor, which can cause severe results after ruptured. This article retrospectively analyzed the clinical symptoms, imaging manifestations, surgical approaches, endovascular therapy and postoperative outcomes of 12 cases with AICA aneurysms, so as to provide reference for clinical practice. Methods Clinical data of patients with AICA aneurysms, who were treated in our hospital between June 2004 and June 2012, were carefully collected and studied. Glasgow Outcome Scale (GOS scores were used to evaluate the patients' living status. Results There were 12 patients (the average age was 54 years old with 13 ruptured aneurysms, accounting for 0.19% of all aneurysms (6467 cases treated in the same period. CT showed simple subarachnoid hemorrhage (SAH in 6 patients, simple ventricular hemorrhage in 1 patient and SAH complicated with ventricular hemorrhage in 5 patients. According to Hunt-Hess Grade, 2 patients were classified as Grade Ⅰ; 7 were Grade Ⅱ; 3 were Grade Ⅲ. Digital subtraction angiography (DSA showed there were 10 saccular aneurysms and 3 fusiform aneurysms. Three aneurysms were located in the proximal segment of AICA (the junction of AICA and basilar artery, 3 premeatal segment (first bifurcation of AICA, 3 meatal and 4 postmeatal. The mean diameter was 3.90 mm. Three patients with 4 aneurysms were treated with microsurgery, of which clipping was carried out in 2 patients with 3 aneurysms and trapping in 1 case. Other 9 patients were treated with endovascular therapy, of which 2 cases underwent coil embolization, 3 stent-assisted coil, and 4 parent artery occlusion (PAO. Postoperative complications included facial paralysis (1 case, dysphagia and coughing when drinking (1 case and contralateral hemianopia in both eyes (1 case. Follow-up was available in all of these cases for a mean of 36.41 months, with GOS scores 3 in 1 case, 4 in 2 cases and 5 in 9

  3. A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

    Directory of Open Access Journals (Sweden)

    Nobuhiro Takeuchi

    2012-01-01

    Full Text Available A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA and pulmonary artery (PA; in addition, we suspected coronary arteriovenous fistula (CAVF. Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1 cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured  cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery.

  4. Evaluation of stent visibility by flat panel detector CT in patients treated for intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Clarencon, Frederic [Groupe Hospitalier Pitie-Salpetriere, Paris (France); Pitie-Salpetriere Hospital, Department of Neuroradiology, Paris (France); Piotin, Michel; Pistocchi, Silvia; Blanc, Raphael [Fondation A. de Rothschild, Paris (France); Babic, Drazenko [Philips Healthcare, Best (Netherlands)

    2012-10-15

    This study aimed to evaluate the visibility of stents using high-resolution computed tomography (CT) acquisitions acquired with flat panel detector (XperCT, Allura series, Philips Healthcare, The Netherlands) for endovascular treatment of intracranial aneurysms. On a 24-month period, 48 patients endovascularly treated by coiling and stenting (59 stents) for intracranial aneurysms were explored by flat panel detector CT technique. A sequence of 620 2D images was acquired over an angle of 240 using a 1,024 x 1,024 pixel matrix detector within a 48-cm field of view. The images were retrospectively analyzed independently by two neuroradiologists. Evaluation criteria were percentage of visualization of the stents and stent deployment (kinking or unsatisfactory deployment of the stent). Evaluation of the stent was feasible for all the patients. Stent visibility by XperCT was overall estimated at 76% of the stent length. Difficulties to analyze the stents were related to coil artifacts but not to packing density or aneurysm location. Stent length visualization was higher when the acquisition was performed before additional coiling (P < 0.0001). Mild kinking/misdeployment was noticed in 22% of the cases. XperCT technique provides multiplanar and 3D reconstructions that allows for a satisfying visualization of intracranial stents. This CT-like acquisition should be performed after the stent deployment and before coiling, in order to obtain better stent visualization. (orig.)

  5. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

    Directory of Open Access Journals (Sweden)

    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  6. Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

    Institute of Scientific and Technical Information of China (English)

    Long Sun; Yong-Song Guan; Hua Wu; Wei-Min Pan; Xiao Li; Qing He; Yuan Liu

    2006-01-01

    A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

  7. Post-operative evaluation of endo vascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Thomaz, Fabiana Barroso; Magalhaes, Fabio Vargas; Magalhaes, Isabela Ferreira de; Caramalho, Monica Ferreira; Kuroki, Iugiro Roberto [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil). Unit of Computed Tomography]. E-mail: fabianabt@terra.com.br; Lopez, Gaudencio Espinosa [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). School of Medicine. Dept. of Surgery; Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteri, RJ (Brazil). Dept. of Radiology; Domingues, Romeu Cortes [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil)

    2008-07-15

    Objective: The present study was aimed at evaluating endo vascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography. Materials and methods: Multidetector computed tomography angiography studies of 166 patients were retrospectively analyzed. The sample included 137 men and 29 women with mean age of 73 years who had undergone endovascular treatment for abdominal aortic aneurysm in the period between June 2005 and August 2006. Images were acquired in a 64-channel multidetector tomograph adopting the following parameters: 0.625 mm collimation, pitch 0.6-1, 300-400 mAs, and 120 kV. A nonionic iodinated contrast agent (350 mg/ml) was injected by infusion pump at a rate of 4 ml/s to 5 ml/s and a variable amount of 70 ml to 100 ml. The studies were evaluated for the presence of complications. Results: Among the 166 cases, 93 patients did not present complications and 73 presented the following findings: endoleak (n=37), circumferential thrombosis (n=29), angulation (n=17), presence of collection at the puncture site (n=10), graft migration (n=7), dissection of access vessels (n=7) and occlusion (n=6). Conclusion: In summary, endoleak was the most prevalent complication in the present series, with type II endoleak being most frequently found. (author)

  8. Intracranial Aneurysms Treated with Coil Placement: Test Characteristics of Follow-up MR Angiography-Multicenter Study

    NARCIS (Netherlands)

    J.D. Schaafsma; B.K. Velthuis; C.B.L.M. Majoie; R. van den Berg; P.A. Brouwer; F. Barkhof; O. Eshghi; G.A.P. de Kort; R.T.H. Lo; T.D. Witkamp; M.E.S. Sprengers; M.A. van Walderveen; J.C. Bot; E. Sanchez; W.P. Vandertop; J. van Gijn; E. Buskens; Y. van der Graaf; G.J.E. Rinkel

    2010-01-01

    Purpose: To determine the test characteristics of magnetic resonance (MR) angiography in the assessment of occlusion of aneurysms treated with coil placement. Materials and Methods: This was an ethics committee-approved multicenter study. Written informed consent was obtained in 311 patients with 34

  9. 都梁软胶囊治疗基底动脉型偏头痛39例%Clinical Therapy Observation of Duliang Soft Capsule for Treating Basilar Artery Migraine in 39 Cases

    Institute of Scientific and Technical Information of China (English)

    陈忠伦; 王欣; 段劲峰

    2012-01-01

    目的 观察都梁软胶囊时基底动脉型偏头痛的治疗效果.方法 将76例患者随机分成治疗组(39例)和对照组(37例),治疗组联合服用都梁软胶囊和尼莫地平,对照组单用尼莫地平,治疗2周,观察疼痛及伴随症状的变化.结果 治疗组比对照组疼痛强度降低更明显(P<0.05),总有效率亦高于对照组(P<0.05).结论联合服用都梁软胶囊治疗基底动脉型偏头痛安全、有效.%Objective To investigate the effect of Duliang Soft Capsule in treating basilar artery migraine. Methods 76 cases of basilar artery migraine were randomly divided into two groups, the treatment group( 39 cases) and the control group( 37 cases ). The treatment group was given Duliang Soft Capsule plus nimodipine, while the control group received nimodipine alone. The change of pain and accompanied symptoms were observed after 2 - week treatment. Results The pain intensity in the treatment group was significantly decreased than the control group( P < 0. 05 ), the total effective rate was also higher than that in the control group( P < 0.05). Conclusion The combination use of Duliang Soft Capsule is safe and effective to treat basilar artery migraine.

  10. Meta-Analysis of the Efficiency and Prognosis of Intracranial Aneurysm Treated with Flow Diverter Devices.

    Science.gov (United States)

    Ye, Gengfan; Zhang, Meng; Deng, Lin; Chen, Xiaohui; Wang, Yunyan

    2016-05-01

    Flow diverter devices (FDDs) are increasingly used in the treatment of intracranial aneurysm. The safety and feasibility of FDD were assessed in published literature. In accordance with strict inclusion criteria, Medline, Embase, Cochrane, China National Knowledge Infrastructure, and Web of Science databases were searched for literature that covers a period until February 2015. The baseline characteristics of patients, aneurysms, aneurysm occlusion, morbidity, and mortality were also collected. A meta-analysis was conducted using STATA 12.0, and a chi-squared test was performed to evaluate whether statistically significant differences existed between complications and mortality of aneurysm patients. Finally, a total of 48 studies were selected, including 2508 patients with 2826 aneurysm cases. The mean follow-up interval is 6.3 months, and the aneurysm occlusion rate is 77.9 % (95 % CI 73.8-81.9, I (2) = 43.4 %). The total morbidity and mortality rates are 9.8 and 3.8 %, respectively. The rates of spontaneous rupture and intraparenchymal hemorrhage are 2.0 and 2.5 %, respectively. The rate of ischemic stroke is 5.5 %. The morbidity and mortality rates of giant aneurysms are significantly higher than those of small and large aneurysms (χ (2) = 56.96, p aneurysms are significantly higher than those of anterior (χ (2) = 11.29, p aneurysms (χ (2) = 10.36, p aneurysm occlusion was detected by Begg's rank, and the corrected result is less than 0.05. Our meta-analysis suggests that the treatment of intracranial aneurysm with FDD is feasible and effective with a high occlusion rate, acceptable morbidity, and mortality. However, the morbidity or mortality of giant aneurysms is still high.

  11. The 'Sphere': A Dedicated Bifurcation Aneurysm Flow-Diverter Device.

    Science.gov (United States)

    Peach, Thomas; Cornhill, J Frederick; Nguyen, Anh; Riina, Howard; Ventikos, Yiannis

    2014-01-01

    We present flow-based results from the early stage design cycle, based on computational modeling, of a prototype flow-diverter device, known as the 'Sphere', intended to treat bifurcation aneurysms of the cerebral vasculature. The device is available in a range of diameters and geometries and is constructed from a single loop of NITINOL(®) wire. The 'Sphere' reduces aneurysm inflow by means of a high-density, patterned, elliptical surface that partially occludes the aneurysm neck. The device is secured in the healthy parent vessel by two armatures in the shape of open loops, resulting in negligible disruption of parent or daughter vessel flow. The device is virtually deployed in six anatomically accurate bifurcation aneurysms: three located at the Basilar tip and three located at the terminus bifurcation of the Internal Carotid artery (at the meeting of the middle cerebral and anterior cerebral arteries). Both steady state and transient flow simulations reveal that the device presents with a range of aneurysm inflow reductions, with mean flow reductions falling in the range of 30.6-71.8% across the different geometries. A significant difference is noted between steady state and transient simulations in one geometry, where a zone of flow recirculation is not captured in the steady state simulation. Across all six aneurysms, the device reduces the WSS magnitude within the aneurysm sac, resulting in a hemodynamic environment closer to that of a healthy vessel. We conclude from extensive CFD analysis that the 'Sphere' device offers very significant levels of flow reduction in a number of anatomically accurate aneurysm sizes and locations, with many advantages compared to current clinical cylindrical flow-diverter designs. Analysis of the device's mechanical properties and deployability will follow in future publications.

  12. 补阳还五汤治疗椎基底动脉供血不足所致眩晕34例%Treating 34 cases of vertigo caused by vertebro-basilar artery insufficiency with the Buyanghuanwu decoction

    Institute of Scientific and Technical Information of China (English)

    万继松; 田中旺

    2012-01-01

      Objective: To observe the clinical effect of the Buyang Huanwu decoction in treating vertigo caused by vertebro-basilar artery insufficiency. Methods: The Buyang Huanwu decoction was given once a day modified with different symptoms. There were 20 days in each course of treatment. The clinical effect was observed after 2 courses of treatment. Results: The total effective rate was 91%. Conclusion: The Buyang Huanwu decoction had significant effect in treating vertigo caused by vertebro-basilar artery insufficiency.%  目的:观察补阳还五汤治疗椎基底动脉供血不足所致眩晕的临床疗效。方法:给予补阳还五汤,并随证加味治疗,1剂/d,20d 为1个疗程,2个疗程后观察疗效。结果:总有效率91%。结论:补阳还五汤治疗基底动脉供血不足所致眩晕疗效显著。

  13. Unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Backes, Daan

    2016-01-01

    Rupture of an intracranial aneurysm results in aneurysmal subarachnoid hemorrhage (SAH), a subtype of stroke with an incidence of 9 per 100,000 person-years and a case-fatality around 35%. In order to prevent SAH, patients with unruptured intracranial aneurysms can be treated by neurosurgical or end

  14. Computational Fluid Dynamics Study of Bifurcation Aneurysms Treated with Pipeline Embolization Device: Side Branch Diameter Study.

    Science.gov (United States)

    Tang, Abraham Yik-Sau; Chung, Wai-Choi; Liu, Eric Tian-Yang; Qu, Jie-Qiong; Tsang, Anderson Chun-On; Leung, Gilberto Ka-Kit; Leung, Kar-Ming; Yu, Alfred Cheuk-Hang; Chow, Kwok-Wing

    An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters. The condition after the deployment of a pipeline embolization device is also simulated. Hemodynamic factors such as flow velocity, pressure, and wall shear stress are studied. Aneurysms with a larger side branch vessel might have greater risk after treatment in terms of hemodynamics. Although a stent could lead to flow reduction entering the aneurysm, it would drastically alter the flow rate inside the side branch vessel. This may result in side-branch hypoperfusion subsequent to stenting. In addition, two patient-specific bifurcation aneurysms are tested, and the results show good agreement with the idealized models. Furthermore, the peripheral resistance of downstream vessels is investigated by varying the outlet pressure conditions. This quantitative analysis can assist in treatment planning and therapeutic decision-making.

  15. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

    Directory of Open Access Journals (Sweden)

    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  16. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Cronqvist, M.; Ramgren, B.; Holtaas, S.; Larsson, E.-M. [Lund University Hospital, Department of Neuroradiology, Lund (Sweden); Wirestam, R. [Lund University Hospital, Department of Radiation Physics, Lund (Sweden); Brandt, L.; Nilsson, O.; Saeveland, H. [Lund University Hospital, Department of Neurosurgery, Lund (Sweden)

    2005-11-01

    Our purpose was to evaluate treatment safety as well as complications frequency and management in endovascular coiling of intracerebral aneurysms using MR diffusion and perfusion imaging. In this prospective study, 77 MR examinations were performed in conjunction with 43 procedures in 40 patients, 14 patients presented with ruptured and 26 with unruptured aneurysms. Mean time interval between treatment and post-procedure MRI was 29 and 25 h for the ruptured and unruptured aneurysm group, respectively. Peri-procedural complications, including five major events and five minor transient events, occurred in 10/43 procedures (23%), necessitating thrombolytic therapy in two patients and angioplasty in one, all three within the unruptured aneurysm group. Fifty-one new lesions were found on post-treatment DWI and 47 of them were regarded as of ischemic origin. Most lesions were small (<3 mm), ipsilateral to the treated aneurysm and asymptomatic (37/40 patients). Sixty-seven percent of the lesions were found in the ruptured and 33% in the unruptured aneurysm group. The ischemic lesions did occur more frequently in patients treated for aneurysm of large neck size and according to the remodelling technique. The overall morbidity and mortality rates were 14.6 and 7.3% whereas morbidity and mortality rates related to the technique were only 2.6 and 0%, respectively. (orig.)

  17. Clinical value of three-dimensional digital subtraction angiography in the endovascular treatment of intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    Tianxiao Li; Dengwei Zong

    2006-01-01

    BACKGROUND: The endovascular treatment of intracranial aneurysms requires clearly displayed anatomic structures of the aneurysm and the reference image of the aneurysm neck, the images of the form and struc ture of the aneurysm and the three-dimensional (3D) intracranial vascular structure are very important for the diagnosis and treatment of cerebral aneurysms. OBJECTIVE: To investigate the value of 3D digital subtraction angiography (3D DSA) in diagnosing intracra nial aneurysm, and compare the reliability with two-dimensional (2D) DSA in evaluating the intracranial aneurysm suitable for the endovascular occlusion: DESIGN: A double-blind case observation. SETTING: Department of Interventional Radiology, Henan People's Hospital. PARTICIPANTS: The patients, who were suspected to have intracranial aneurysms, were examined with 2D DSA and 3D DSA in Henan People's Hospital from October 2004 to October 2005. Fifty intracranial aneurysms were detected in 44 patients (19 males and 25 females) of 30-75 years, with an average of 51 years, including 5 cases were multiple aneurysms, including 2 aneurysms in 4 cases and 3 aneurysms in 1 case. The aneurysms located respectively at internal carotid artery (n =19), anterior cerebral artery (n =16), middle cerebral artery (n =8), basilar artery (n =6), and posterior inferior cerebellar artery (n =1 ). METHODS: The 50 ruptured intracranial aneurysms were examined with 2D DSA and 3D DSA. The method of volume reconstruction was applied to reconstruct the 3D DSA images, and the automatically generated images could be shifted, rotated and magnified, besides, the corresponding processing could also be performed, including resecting the unnecessary structure and sharpening margin of the images. Observations: ① Display of aneurysm neck: The site and range of the aneurysm neck, and the involvement of branches originated from the aneurysm arteries; ② Display of aneurysm form: The displays of aneurysm form and with or without arteries

  18. 黄豆苷元联合倍他司汀治疗椎-基底动脉供血不足96例%Treating 96 cases of vertebro-basilar artery insufficiency with Daidzein and Betahistine

    Institute of Scientific and Technical Information of China (English)

    赵亚恒; 阴伟利; 钱仁义

    2015-01-01

    目的:观察黄豆苷元联合倍他司汀治疗椎-基底动脉供血不足的临床疗效。方法:将96例椎-基底动脉供血不足患者随机分成治疗组和对照组,治疗组应用黄豆苷元联合倍他司汀片,对照组应用倍他司汀片。结果:治疗组总有效率为87.5%,对照组总有效率为79.17%,差异有统计学意义(P<0.0l)。结论:黄豆苷元联合倍他司汀片组的疗效高于倍他司汀片组,故黄豆苷元联合倍他司汀是治疗老年人椎-基底动脉供血不足型眩晕的有效方法。%Objective:To observe clinical efficacy of Daidzein and Betahistine on vertebro-basilar artery insufficiency. Methods:96 cases were randomly divided into the treatment group and the control group. The treatment group took Daidzein and Betahistine; the control group took Betahistine. Results: The total efficiency was 87.5%in the treatment group and 79.1%in the control group. P<0.01. Conclusion:Treating vertebro-basilar artery insufficiency with Daidzein and Betahistine could receive better efficacy.

  19. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    CERN Document Server

    Egger, Jan; Freisleben, Bernd

    2016-01-01

    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, ...

  20. Hemifacial spasm in a patient with basilar artery dolichoectasia caused by uncontrolled hypertension

    Directory of Open Access Journals (Sweden)

    Gordon S. Crabtree

    2016-10-01

    Full Text Available A 47-year-old male presented with a 2-year history of hemifacial spasm. Magnetic resonance imaging performed showed his tortuous basilar artery with nerve compression, and the patient was treated conservatively with botulinum toxin injections with complete resolution of symptoms. This rare disease was caused by his long history of hypertension, which led to his major basilar artery dolichoectasia.

  1. Impact of anatomical variations of the circle of Willis on the incidence of aneurysms and their recurrence rate following endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Songsaeng, D. [Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto (Canada); Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok (Thailand); Geibprasert, S.; Willinsky, R. [Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto (Canada); Tymianski, M. [Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto (Canada); TerBrugge, K.G. [Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto (Canada); Krings, T., E-mail: timo.krings@uhn.on.c [Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto (Canada)

    2010-11-15

    Aim: To analyse the impact of anatomical variations of the parent arteries on the incidence and recurrence rate following coil embolization of aneurysms of the anterior (AcoA), posterior communicating artery (PcoA) and basilar artery (BA) tip. Methods: Two hundred and two (96 AcoA, 67 PcoA, and 29 BA) aneurysms in 200 patients were treated with coil embolization between January 2000 and April 2008. Parent artery variations at each location were classified as: AcoA: A1 aplasia versus hypoplasia versus symmetrical size; PcoA: foetal origin versus medium versus small size, BA: cranial versus caudal versus asymmetrical fusion. The incidence of aneurysms and difference between recurrence rates for each group were recorded on follow-up. Results: AcoA, PcoA, and BA aneurysms were more often associated with embryonically earlier vessel wall dispositions (A1 aplasia, foetal PcoA, asymmetrical fusion). Two of these variations were also associated with aneurysm recurrence following coil embolization: asymmetrical A1 segment (p = 0.01), and asymmetrical BA tip (p = 0.02). Conclusions: AcoA, PcoA, and BA tip aneurysms tend to occur more often in anatomically variant parent artery dispositions, some of which are related to aneurysm recurrence following coil embolization. This may relate to a more fragile vessel disposition as it is not fully matured or to altered haemodynamics secondary to the anatomical variations.

  2. Ventriculoperitoneal shunt in a patient with ruptured blister aneurysm treated with pipeline embolization device.

    Science.gov (United States)

    Tan, Lee A; Gerard, Carter S; Keigher, Kiffon M; Moftakhar, Roham; Lopes, Demetrius K

    2015-03-01

    Cerebral spinal fluid (CSF) diversion is frequently required in patients with aneurysmal subarachnoid hemorrhage who develop subsequent hydrocephalus. Procedures such as external ventricular drain (EVD) and ventriculoperitoneal shunt (VPS) usually carry a very low rate of complications. However, as flow diverting stents such as Pipeline Embolization Device (PED) become more widely available, flow diverters are being used in treatment of some ruptured complex aneurysms. EVD and VPS placement in the setting of dual antiplatelet therapy (DAT) in these patients are associated with a significant risk of intracranial hemorrhage. We describe a management strategy and surgical technique that can minimize hemorrhagic complications associated with VPS in patients on DAT after treatment with flow diverting stents.

  3. Ruptured Left Gastric Artery Aneurysm Successfully Treated by Thrombin Injection: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    S. Chandran

    2005-01-01

    Full Text Available This short report describes the successful use of a new minimally invasive technique for the treatment of acute gastric artery aneurysm rupture. It emphasises the importance of persistence and multiple imaging modalities in the presence of gastrointestinal bleeding. The photographs and case history clearly illustrate the nonoperative management and highlight learning points for experienced surgeons and trainees alike in the management of this potentially fatal condition.

  4. Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy

    DEFF Research Database (Denmark)

    Khan, Sabrina; Amin, Faisal Mohammad; Hauerberg, John

    2016-01-01

    BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriove......BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral...... arteriovenous malformations (AVMs) and aneurysms. METHODS: A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.......g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria. RESULTS: The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5...

  5. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, B.J.; Kim, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Han, M.H.; Chang, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Clinical Research Institute, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Institute of Radiation Medicine, Seoul National University Medical Research Centre, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Seoul National University College of Medicine (Korea); Oh, C.W. [Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea)

    2003-08-01

    We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women - 2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved. (orig.)

  6. Time-of-flight MR angiography at 3 T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils

    Energy Technology Data Exchange (ETDEWEB)

    Ferre, Jean-Christophe [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France)], E-mail: jean-christophe.ferre@chu-rennes.fr; Carsin-Nicol, Beatrice [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Morandi, Xavier [Department of Neurosurgery, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Carsin, Michel [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Kersaint-Gilly, Axel de [Department of Neuroradiology, Hopital Laennec, University Hospital Nantes, Boulevard Jacques Monod, 44800 Saint-Herblain (France); Gauvrit, Jean-Yves [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Desal, Hubert-Armand [Department of Neuroradiology, Hopital Laennec, University Hospital Nantes, Boulevard Jacques Monod, 44800 Saint-Herblain (France)

    2009-12-15

    Objective: To compare 3D time-of-flight MR angiography (TOF-MRA) at 3 Tesla (3 T) with digital subtraction angiography (DSA) for the evaluation of intracranial aneurysm occlusion after endovascular coiling. Methods: In a prospective study, 51 consecutive patients (25 females, 26 males; median age, 51 years) with 51 saccular aneurysms treated with endovascular coiling underwent simultaneous DSA and 3 T TOF-MRA at follow-up. DSA and TOF-MRA images were analyzed independently by two senior neuroradiologists. Findings were assigned to 1 of 3 categories in the Raymond classification: complete obliteration, residual neck or residual aneurysm. Agreement between observers and techniques was evaluated using {kappa} statistics. Results: DSA images were not interpretable for one patient. Interobserver agreement was determined as excellent for DSA ({kappa} = 0.86) and TOF-MRA ({kappa} = 0.80). After reaching a consensus, DSA follow-up showed 26 (51%) complete obliterations, 20 (39%) residual necks and 4 (8%) residual aneurysms. TOF-MRA showed 23 (45%) complete obliterations, 22 (43%) residual necks and 6 (12%) residual aneurysms. Comparison between TOF-MRA and DSA showed excellent agreement between the techniques ({kappa} = 0.86). In the four cases that were misclassified, TOF-MRA findings were assigned to a higher class than for DSA. Conclusion: TOF-MRA at 3 T is at least as efficient as DSA for the evaluation of intracranial aneurysm occlusion after endovascular treatment with detachable coils. We suggest that TOF-MRA at 3 T might be used as the primary method for imaging follow-up of coiled intracranial aneurysms.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    McGloughlin Tim M

    2009-10-01

    Full Text Available Abstract 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.

  9. Basilar impression and osteogenesis imperfecta in a three-year-old girl: CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Rush, P.J.; Berbrayer, D.; Reilly, B.J.

    1989-01-01

    A 3-year-old girl with osteogenesis imperfecta developed symptomatic basilar impression. Her neurological symptoms were treated by foramen magnum decompression and laminectomy. This is an unusually young patient to have this condition.

  10. Frequency and appearance of hemosiderin depositions after aneurysmal subarachnoid hemorrhage treated by endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    Falter, Bernhard; Wiesmann, Martin; Freiherr, Jessica; Nikoubashman, Omid; Mull, Michael [University Hospital Aachen RWTH, Department of Neuroradiology, Aachen (Germany)

    2015-10-15

    It is still unclear how often subarachnoid hemorrhage (SAH) leads to chronic hemosiderin depositions. In this study, we aimed to determine the frequency of chronic hemosiderin depositions after aneurysmal SAH in patients who did not undergo surgery. Furthermore, we analyzed typical MRI patterns of chronic SAH and sought to obtain information on the temporal course of MRI signal changes. We retrospectively analyzed 90 patients who had undergone endovascular treatment for acute aneurysmal SAH. In all patients, initial CT studies and at least one T2*-weighted MRI obtained 6 months or later after SAH were analyzed for the presence and anatomical distribution of SAH or chronic hemosiderin depositions. In total, 185 T2*-weighted MRI studies obtained between 2 days and 148 months after SAH were evaluated (mean follow-up 30.2 months). On MRI studies obtained later than 6 months after SAH, subpial hemosiderin depositions were found in 50 patients (55.5 %). Most frequent localizations were the parenchyma adjacent to the frontal and parietal sulci and the insular cisterns. While the appearance of hemosiderin depositions was dynamic within the first 3 months, no changes were found during subsequent follow-up. MR signal changes were not only conclusive with subarachnoid hemosiderin depositions but in many cases also resembled those that have been associated with cortical hemosiderosis. T2*-weighted MRI is an effective means of diagnosing prior SAH. Our study suggests that chronic hemosiderin depositions can be found in a considerable number of patients after a single event of subarachnoid hemorrhage. (orig.)

  11. A Literature Review of the Numerical Analysis of Abdominal Aortic Aneurysms Treated with Endovascular Stent Grafts

    Directory of Open Access Journals (Sweden)

    David Roy

    2012-01-01

    Full Text Available The purpose of this paper is to present the basic principles and relevant advances in the computational modeling of abdominal aortic aneurysms and endovascular aneurysm repair, providing the community with up-to-date state of the art in terms of numerical analysis and biomechanics. Frameworks describing the mechanical behavior of the aortic wall already exist. However, intraluminal thrombus nonhomogeneous structure and porosity still need to be well characterized. Also, although the morphology and mechanical properties of calcifications have been investigated, their effects on wall stresses remain controversial. Computational fluid dynamics usually assumes a rigid artery wall, whereas fluid-structure interaction accounts for artery compliance but is still challenging since arteries and blood have similar densities. We discuss alternatives to fluid-structure interaction based on dynamic medical images that address patient-specific hemodynamics and geometries. We describe initial stresses, elastic boundary conditions, and statistical strength for rupture risk assessment. Special emphasis is accorded to workflow development, from the conversion of medical images into finite element models, to the simulation of catheter-aorta interactions and stent-graft deployment. Our purpose is also to elaborate the key ingredients leading to virtual stenting and endovascular repair planning that could improve the procedure and stent-grafts.

  12. Efficacy analysis of alprostadil combined with betahistine in treating vertebral-basilar artery insufficiency%前列地尔联合倍他司汀治疗椎-基底动脉供血不足的疗效分析

    Institute of Scientific and Technical Information of China (English)

    肖有为; 许彩芹; 庞燕; 刘宇鹏

    2011-01-01

    目的 观察前列地尔联合倍他司汀治疗椎-基底动脉供血不足的临床疗效.方法 将136例椎-基底动脉供血不足患者随机分为前列地尔联合倍他司汀治疗组(68例)和倍他司汀对照组(68例),观察临床疗效及治疗前后椎-基底动脉平均血流速度的改善情况.结果 治疗组治愈率及总有效率高于对照组(P<0.05);治疗组各动脉平均血流速度均明显较对照组改善(P<0.05).结论 前列地尔联合倍他司汀治疗椎-基底动脉供血不足疗效显著.%Objective To observe the clinical efficacy of alprostadil combined with betahistine in treating vertebral-basilar artery insufficiency.Methods 136 patients with vertebral-basilar artery insufficiency were randomly divided into alprostadil combined with betahistine treatment group (68 cases) and betahistine control group (68 cases), clinical efficacy and the improvement of vertebral-basilar artery mean blood flow rate was observed before and after treatment.Results The cure rate and total effective rate of treatment group were higher ( P < 0.05 ); Artery mean blood flow velocity of treatment group were improved significantly than that in control group ( P < 0.05 ).Conclusion It is effective to treat the vertebral-basilar artery insufficiency with alprostadil combined with betahistine.

  13. Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.

    Science.gov (United States)

    Lansen, T A; Kasoff, S S; Arguelles, J H

    1989-07-01

    Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

  14. A Case of Ruptured Blood Blister-like Aneurysm Treated with Pipeline Embolization Device: Clinical Significance of Fetal-type Posterior Communicating Artery

    Science.gov (United States)

    Park, Ki-Su; Son, Won-Soo; Park, Jaechan; Kim, Young-Sun; Kim, Byung Moon

    2017-01-01

    Blood-blister like aneurysms (BBAs) are challenging lesions because of their wide fragile neck. Flow-diverting stents (FDSs), such as the Pipeline Embolization Device (PED), have been applied to treat BBAs less amenable to more established techniques of treatment. However, the use of FDSs, including the PED, in acute subarachnoid hemorrhage (SAH) still remains controversial. We report a case of aneurysm regrowth following PED application for a ruptured BBA that overlapped the origin of the dominant posterior communicating artery (PCoA), which was successfully treated after coil trapping of the origin of the fetal-type PCoA. And, we discuss the clinical significance of the fetal-type PCoA communicating with a BBA in terms of PED failure. PMID:28316868

  15. Microsurgical management of posterior circulation aneurysms%后循环动脉瘤显微外科手术治疗

    Institute of Scientific and Technical Information of China (English)

    石祥恩; 张永力; 吴斌; 周忠清; 孙玉明; 刘方军; 钱海; 范涛; 李志强

    2012-01-01

    Objective To retrospectively analyze effective methods for surgical management of posterior circulation aneurysms. Methods There were 42 patients with posterior circulation aneurysms [26 cases of basilar aneurysm (27 aneurysms), 16 cases of vertebral aneurysm (17 aneurysms)]. There were 15 patients underwent bypass surgery [4 external carotid artery - P2 segment of posterior cerebral artery (ECA - P2), 2 internal carotid artery - P2 segment of posterior cerebral artery (ICA - P2), 2 internal maxillary artery-P2 segment of posterior cerebral artery (IMA-P2), 2 intracranial segment of vertebral artery-extracranial segment of vertebral artery, 5 occipital artery - posterior inferior cerebellar artery (OA-PICA)] and 27 patients underwent simple surgical clipping. Results Activities of daily life of 37 patients recovered to normal (14 patients with aneurysm on the top of basilar artery, 3 with aneurysm on the trunk of basilar artery, 9 with vertebral aneurysm, 5 with posterior inferior cerebellar artery aneurysm, 4 with aneurysm on the junction of P1-P2 segment of posterior cerebral artery, 1 with superior cerebellar artery, and 1 with anterior inferior cerebellar aneurysm). None of them occurred operation - related neurological dysfunction. The recovery rate was 88.09%. Among the other patients, 1 with aneurysm on the top of basilar artery presented severe signs and symptoms of neurological defect and cannot take care of oneself, 2 patients (1 with aneurysm on the top of basilar artery, 1 with aneurysm on the trunk of basilar artery) occurred brain stem hemorrhage after operation, and died at perioperative period, 2 with vertebral aneurysm relapsed and was cured after treatment. Conclusion Posterior circulation aneurysm which is not suitable for surgical clipping can be treated with intra- and extra - cranial vessel bypass. It may avoid the risk of surgical clipping of aneurysm.%目的 探讨后循环动脉瘤手术适应证和治疗效果.方法 纳入42例共44个

  16. SOMATOSENSORY EVOKED-POTENTIALS IN CEREBRAL ANEURYSM SURGERY

    NARCIS (Netherlands)

    BUCHTHAL, A; BELOPAVLOVIC, M

    1992-01-01

    Monitoring of median nerve somatosensory evoked potentials (SSEP) during surgery for a basilar artery aneurysm under moderate hypothermia revealed an unexpected loss of the first cortical peak. This was due to compression of the middle cerebral artery under the retractor during the surgical approach

  17. Treatment strategies for aneurysms associated with moyamoya disease.

    Science.gov (United States)

    Zhang, Lei; Xu, Kan; Zhang, Yandong; Wang, Xin; Yu, Jinlu

    2015-01-01

    The treatment of aneurysms associated with moyamoya disease (MMD) is difficult for neurosurgeons, and little is known of strategy options. This report constitutes a comprehensive review of the literature. We summarize the known treatments and their clinical outcomes according to the site of the aneurysm: in major arteries, peripheral arteries, moyamoya vessels, meningeal arteries, or at the site of anastomosis. The literature review indicates that the treatment of MMD-associated aneurysms varies according to the site of the aneurysm and its hemodynamic characteristics. In particular, the treatment for basilar tip aneurysms remains challenging, since both endovascular embolization and direct clipping are difficult. The potential risk for ischemia should be considered in selecting endovascular or surgical approaches. Revascularization surgery, which is important for the treatment of MMD, also determines the clinical treatment outcome of aneurysms associated with MMD.

  18. [Popliteal aneurysms].

    Science.gov (United States)

    Vaquero Morillo, F; Zorita Calvo, A; Fernández-Samos Gutiérrez, R; García Vázquez, J; Ortega Martín, J M; Fernández Morán, C

    1992-01-01

    We presented the review of 22 cases of popliteal aneurysms with a follow-time of three years. One case was a woman and 5 cases were bilaterals. The most part of cases begun as a latter acute ischemia. Sixteen cases were treated surgically, with a null rate of mortality, 2 amputations, 4 cases of residual intermittent claudication and 10 no-symptomatic patients, with present distal pulses. Etiology, clinical presentation, diagnosis, technics and results are presented and a comparison with other authors is made. Our experience support an interventionist attitude in cases of elderly nonsymptomatic patients, performed by internal way and saphenous vein substitution.

  19. Electroencephalograms in basilar artery migraine.

    Science.gov (United States)

    Parain, D; Samson-Dollfus, D

    1984-11-01

    Nine cases of 'basilar artery migraine' (BAM) have been recorded. In 8 cases, excess of beta activity was observed during the attacks and disappeared in less than 3 days. The inter-ictal EEGs were normal. Drug ingestion was excluded each time. These EEG patterns are different from those which have been reported in the literature, i.e., transitory posterior abnormal slow waves. However, case no.1 is in agreement with the literature. The expression 'BAM' probably covers different syndromes which are further discussed.

  20. 耳针联合倍他司汀治疗椎基底动脉供血不足临床疗效回顾性分析%A retrospective analysis of treating vertebral basilar insufifciency by auricular acupuncture plus Betahistine

    Institute of Scientific and Technical Information of China (English)

    汪建平; 辛庆锋

    2016-01-01

    Objective: To retrospectively analyze clinical effects and safety of auricular acupuncture plus Betahistine on vertebral basilar insufficiency. Methods: 56 cases were randomly divided into 2 groups. The control group was given low molecular dextran; the observed group was treated by auricular acupuncture plus Betahistine. Results: The total efficiency and vertebral-basilar artery hemodynamic improvement in the observed group were both obviously better,P0.05). Conclusion: Auricular acupuncture plus Betahistine on vertebral basilar insufifciency showed a signiifcant effects, with safety, and was worthy of promotion.%目的:回顾性分析耳针联合倍他司汀治疗椎基底动脉供血不足的临床疗效及安全性。方法:回顾分析本院2011年1月-2013年12月收治的56例椎基底动脉供血不足患者,依据纠正眩晕的治疗方法分为两组。对照组给予低分子右旋糖酐,观察组给予耳针联合倍他司汀。结果:观察组在临床疗效、椎基底动脉血液动力学改善等方面均明显优于对照组(P0.05)。结论:耳针联合倍他司汀治疗椎基底动脉供血不足疗效显著且安全可靠,值得临床选择和推广。

  1. Multislice CT Angiography of Fenestrated Endovascular Stent Grafting for Treating Abdominal Aortic Aneurysms: a Pictorial Review of the 2D/3D Visualizations

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Zhonghua [Curtin University, Perth (Australia); Mwipatayi, Bibombe P [Royal Perth Hospital, Perth (Australia); Allen, Yvonne B; Hartley, David E [Cook R and D, Perth (Australia); Lawrence-Brown, Michael M [Curtin University of Technology, Perth (Australia)

    2009-06-15

    Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images

  2. Basilar invagination, Chiari malformation, syringomyelia: A review

    Directory of Open Access Journals (Sweden)

    Goel Atul

    2009-01-01

    Full Text Available Institute and personal experience (over 25 years of basilar invagination was reviewed. The database of the department included 3300 patients with craniovertebral junction pathology from the year 1951 till date. Patients with basilar invagination were categorized into two groups based on the presence (Group A or absence (Group B of clinical and radiological evidence of instability of the craniovertebral junction. Standard radiological parameters described by Chamberlain were used to assess the instability of the craniovertebral junction. The pathogenesis and clinical features in patients with Group A basilar invagination appeared to be related to mechanical instability, whereas it appeared to be secondary to embryonic dysgenesis in patients with Group B basilar invagination. Treatment by facetal distraction and direct lateral mass fixation can result in restoration of craniovertebral and cervical alignment in patients with Group A basilar invagination. Such a treatment can circumvent the need for transoral or posterior fossa decompression surgery. Foramen magnum bone decompression appears to be a rational surgical treatment for patients having Group B basilar invagination. The division of patients with basilar invagination on the basis of presence or absence of instability provides insight into the pathogenesis of the anomaly and a basis for rational surgical treatment.

  3. Partially uncovered Cheatham platinum-covered stent to treat complex aortic coarctation associated with aortic wall aneurysm.

    Science.gov (United States)

    Butera, Gianfranco; Piazza, Luciane

    2015-04-01

    Percutaneous treatment of aortic coarctation is a widely used option. Covered stents have increased the profile of efficacy and safety of this procedure. Here we report on a 32-year-old woman with significant aortic recoarctation associated with aortic wall aneurysm and close proximity of both lesions to the origin of both the subclavian arteries. It was decided to manually and partially uncover the proximal part of the stent to have a hybrid stent that could act as a bare stent at the level of the origin of the subclavian arteries and as a covered stent at the level of the aneurysm.

  4. Phase contrast MRI in intracranial aneurysms

    NARCIS (Netherlands)

    van Ooij, P.

    2012-01-01

    Intracranial aneurysms are outpouchings of intracranial arteries that cause brain hemorrhage after rupture. Unruptured aneurysms can be treated but the risk of treatment may outweigh the risk of rupture. Local intra-aneurysmal hemodynamics can contribute substantially to the rupture risk estimation

  5. Mesenteric ischaemia after endovascular coiling of ruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

    Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.

  6. 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, ...

  7. Vascular dynamics of a shape memory polymer foam aneurysm treatment technique.

    Science.gov (United States)

    Ortega, Jason; Maitland, Duncan; Wilson, Tom; Tsai, William; Savaş, Omer; Saloner, David

    2007-11-01

    The vascular dynamics of a shape memory polymer foam aneurysm treatment technique are assessed through the simulated treatment of a generic basilar aneurysm using coupled fluid dynamics and heat transfer calculations. The shape memory polymer foam, which expands to fill the aneurysm when heated, is modeled at three discrete stages of the treatment procedure. To estimate an upper bound for the maximum amount of thermal damage due to foam heating, a steady velocity is specified through the basilar artery, corresponding to a minimum physiological flow velocity over a cardiac cycle. During expansion, the foam alters the flow patterns within the aneurysm by shielding the aneurysm dome from a confined jet that issues from the basilar artery. The time scales for thermal damage to the artery walls and surrounding blood flow are computed from the temperature field. The flow through the post-treatment bifurcation is comprised of two counter-rotating vortex tubes that are located beneath the aneurysm neck and extend downstream into the outlet arteries. Beneath the aneurysm neck, a marked increase in the wall shear stress is observed due to the close proximity of the counter-rotating vortex tubes to the artery wall.

  8. Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Michele; Virgilio, Edoardo; Laurino, Florindo; Orgera, Gianluigi; Mene, Paolo; Pirozzi, Nicola; Ziparo, Vincenzo; Cavallini, Marco [St. Andrea Hospital, Rome (Italy)

    2015-08-15

    The occurrence of a giant hepatic artery aneurysm (GHAA) in a patient with systemic vasculitis is very rare. Herein, we describe our endovascular treatment experience of a GHAA associated with immunoglobulin G4-related disease (IgG4-RD) consisting primarily of a liquid embolic injection and deployment of a vascular plug.

  9. The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion

    Science.gov (United States)

    Xianxian, Zhao; Chengsong, Yue; Qiang, Mei; Fei, Wei; Lin, Shen; Huiyan, Ding; Zili, Gong

    2017-01-01

    In order to further optimize the treatment strategy for the patients with acute basilar artery occlusion, we were dedicated to study the therapeutic effects and influential factors in the process of treated basilar artery occlusion with thrombolytic combined vascular interventional therapy. 75 patients with acute basilar artery occlusion treated with arterial thrombolytic therapy were analyzed retrospectively. In accordance with the discharge records of patients, their short-term curative effect with 24-hour treatment and 14-days treatment were evaluated. Our data showed that the survival condition of the patients with acute acute basilar artery occlusion were visibly improved by combination thrombolytic and interventional therapy. Moreover, their BI scores were remarkably improved, while NIHSS and mRS scores were evidently reduced. These data proved that our treatment strategy was able to improve the survival condition of patients with acute basilar artery occlusion. Furthermore, our data showed that coagulation related factors remarkably improved in the patients, when they treated by combination thrombolytic therapy with interventional therapy. In addition, our results suggested that the patients' bilateral Babinski(+), revascularization and coma symptom were closely related to their prognosis after treated the patients with combination thrombolytic and vascular interventional therapy, and the difference was statistically significant (pBabinski(+), and revascularization in the patients with acute basilar artery occlusion have an appreciable impact on the patients' prognosis. PMID:28123346

  10. Basic flow structure in saccular aneurysms: a flow visualization study.

    Science.gov (United States)

    Steiger, H J; Poll, A; Liepsch, D; Reulen, H J

    1987-01-01

    Basic flow patterns were investigated in a set of glass aneurysm models by means of flow visualization methods. Dye injection and streaming double refraction were used to visualize flow. The circulation inside lateral aneurysms arising at a 90 degree angle from a straight parent conduit could not be visualized by the dye-injection technique but could be demonstrated by streaming double refraction. The inflow was seen to arise from the downstream lip of the orifice and to project to the dome of the aneurysm. Backflow to the parent conduit took place along the walls of the aneurysm. In aneurysms located at bifurcations, flow characteristics depended on the geometry of the bifurcation and the flow ratio between the branches. Relatively little intra-aneurysmal flow was demonstrated in side branch-related aneurysms arising distal to an asymmetric 90 degrees bifurcation of the type encountered at the junction of the internal carotid and posterior communicating arteries. Stagnation of flow at the neck and little intra-aneurysmal circulation were found with terminal aneurysms of the basilar bifurcation type if the outflow through the branches was symmetric. With asymmetric outflow, however, or if the axis of the aneurysm did not coincide with that of the afferent vessel, an active rotation developed in these aneurysms. The size of the aneurysm had no influence on the basic pattern of intra-aneurysmal circulation. The use of pulsatile perfusion did not significantly alter the basic flow patterns observed with steady flow. Locally disturbed laminar flow was observed in certain models at physiological Reynold's numbers, but there were no signs of fully developed turbulence.

  11. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jung Min; Park, Kwang Bo; Kim, Keon Ha; Jeon, Pyoung; Shin, Sung Wook; Park, Hong Suk; Do, Young Soo (Dept. of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)), email: kbparksmc@skku.edu; Kim, Dong-Ik; Kim, Young-Wook (Div. of Vascular Surgery, Dept. of Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of))

    2011-10-15

    Background: There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose: To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA. Material and Methods: Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The post embolization MDCT follow-up findings were analyzed retrospectively. Results: The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and Postprocedural hypertension developed in two patients during the follow-up period. Conclusion: The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension

  12. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Su, I. Chang [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Taipei Cathay General Hospital, Division of Neurosurgery, Department of Surgery, Taipei (China); Willinsky, Robert A.; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Fanning, Noel F. [Cork University Hospital, Department of Interventional Neuroradiology, Cork (Ireland)

    2014-06-15

    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.)

  13. Aneurysms of medium-sized arteries in Marfan syndrome.

    Science.gov (United States)

    Awais, Mazen; Williams, David M; Deeb, G Michael; Shea, Michael J

    2013-11-01

    Marfan syndrome is a relatively common connective tissue disorder that causes skin, ocular, skeletal, and cardiovascular abnormalities. High morbidity and mortality occur with aortic aneurysm and dissection. Other large-artery aneurysms, including carotid, subclavian, and iliac artery aneurysms, have also been associated with Marfan syndrome. It is not clear whether small- to medium-sized artery aneurysms are associated with Marfan syndrome. This report describes 4 patients with Marfan syndrome who have associated small- to medium-sized artery aneurysms with several complications. Additional investigations are needed to determine whether Marfan syndrome can cause small- to medium-sized artery aneurysms and how patients with these aneurysms should be treated.

  14. [Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry].

    Science.gov (United States)

    Grunwald, I Q; Struffert, T; Roth, C; Papanagiotou, P; Scheuermann, J; Voges, M; Reith, W

    2005-05-01

    Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome.

  15. Hipnoticos corticales y basilares y acciones anticonvulsivantes

    OpenAIRE

    Carlos Gutiérrez-Noriega

    2013-01-01

    Se estudian las diferencias de los hipnóticos corticales y basilares desde el punto de vista de sus acciones anticonvulsivantes. Los resultados son los siguientes: 1. Los hipnóticos del grupo basilar (barbitúrico y uretano) poseen un poder anticonvulsivante considerablemente mayor que los hipnóticos del grupo cortical (alcoholes, aldehidos, bromuros, éter), con excepción del sulfato de magnesia, clasificado en el grupo subcortical, que tiene muy poca acción anticonvulsivante. 2. Algunos hipnó...

  16. 儿童颅内动脉瘤血管内治疗%Endovascular treatment for pediatric intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    李德洋; 石义亭; 吕宪利; 姜除寒

    2009-01-01

    目的 报道儿童颅内动脉瘤血管内治疗的特征和血管内治疗的结果.方法 2002-2006年收治29例儿童动脉瘤患者(年龄<19岁);其中14例蛛网膜下腔出血,10例意外发现,2例脑神经麻痹,3例神经功能障碍.动脉瘤的位置:10个椎动脉动脉瘤,5个大脑中动脉瘤,4个大脑后动脉瘤,3个基底动脉动脉瘤,3个前交通动脉瘤,1个小脑后下动脉瘤,2个大脑前动脉瘤,1个颈内动脉动脉瘤.结果 7例动脉瘤行动脉瘤囊内弹簧圈栓塞,17例载瘤动脉闭塞(9例使用球囊闭塞载瘤动脉,8例使用弹簧圈载瘤动脉闭塞).1例椎动脉瘤病人全脑血管造影后4 d动脉瘤白发血栓形成.4例行支架或者支架辅助弹簧圈栓塞动脉瘤(其中2例基底动脉瘤患者死亡,2例动脉瘤栓塞后复发并再次给予栓塞治疗).平均随访20.7个月,93.1%的病人GOS评分4分或5分.结论 儿童颅内动脉瘤在发病特点上,男性比女性多见,好发部位是椎动脉、大脑后动脉和人脑中动脉.对于梭形动脉瘤行载瘤动脉闭寒是一种安全有效的治疗方法.基底动脉主十的梭形动脉瘤治疗困难而且死亡率高.%Objective To study the characteristics and therapeutic outcomes of pediatric intracranial aneurysms. Method From 2002 to 2006, 29 pediatric patients (age < 19 years) with intraeranial aneurysm were treated in our institute. Fourteen of 29 patients had SAH. In 10 patients, the aneurysm was an incidental finding. Two patients presented with cranial nerves dysfunction and 3 with neurological deficits. The location of aneurysms were as follows: vertebral artery(n = 5), posterior cerebral artery(n =4), basilar artery(n =3), anterior communicating artery(n =3) ,posterior inferior cerebellar artery (n = 1), anterior cerebral artery (n = 2), internal carotid artery (n = 1). Results Seven patients were treated with selective embolization with coils. Seventeen patients were treated with parent vessel occlusion(POV). Nine POV

  17. A contribution to the controversy over dimethyl sulfoxide toxicity: anesthesia monitoring results in patients treated with Onyx embolization for intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Pamuk, A.G.; Aypar, U. [Hacettepe University Hospital, Department of Anesthesia, Sihhiye, Ankara (Turkey); Saatci, I.; Cekirge, H.S. [Hacettepe University Hospital, Department of Radiology, Ankara (Turkey)

    2005-05-01

    Onyx injection is a new technique for embolization of cerebral aneurysms that is involved in a controversy about the 'toxicity' of its solvent, dimethyl sulfoxide (DMSO). We retrospectively studied 38 patients treated for aneurysms with the liquid polymer, Onyx. Induction was with propofol, fentanyl and vecuronium, and anesthesia was maintained with isoflurane in O{sub 2} and N{sub 2}O. The patients were given 500 ml of fluid after induction, and bradycardia was prevented in order to keep patients hyperdynamic. Electrocardiography (ECG), non-invasive blood pressure (NIBP), pulse oximetry, core temperatures, invasive blood pressure (BP), etCO{sub 2}, and urine output were monitored throughout the intervention. Heart rate and BP changes in response to balloon inflation, DMSO injection, Onyx injection and balloon deflation were recorded. The patients were followed with serial neurological examinations, computerized tomography and/or magnetic resonance imaging postoperatively for evidence of any neurological injury. Cumulative DMSO doses were always well under previously implicated doses for systemic toxicity. No changes implicating toxic reactions were observed during DMSO and Onyx injections. Balloon-induced changes returned to baseline within 1 min of balloon deflation. Technique-related permanent morbidity occurred in two patients (worsening of cranial nerve palsies in one and monocular blindness in another) and intracranial hemorrhage with resulting death in one patient. All patients showed a tendency to oxygen desaturation, but this finding did not cause any clinical consequence. Anesthesiologists need to be vigilant in monitoring patients treated with techniques that are new or are being developed. We have seen no evidence of toxicity or any anesthetic complications in our group of patients, our only clinical concern being a tendency to oxygen desaturation, which may be explained by the inhalational elimination of DMSO. (orig.)

  18. 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 ...

  19. Spontaneous regression of intracranial aneurysm following remote ruptured aneurysm treatment with pipeline stent assisted coiling.

    Science.gov (United States)

    Tsimpas, Asterios; Ashley, William W; Germanwala, Anand V

    2016-10-01

    Spontaneous aneurysm regression is a rare phenomenon. We present the interesting case of a 54-year-old woman who was admitted with a Hunt/Hess grade IV, Fisher grade III subarachnoid hemorrhage and multiple intracranial aneurysms. She was treated with coiling of the largest paraclinoid aneurysm and placement of a flow diverting pipeline embolization device that covered all internal carotid artery (ICA) aneurysms. A follow-up angiogram at 6 months showed remodeling of the ICA with complete obliteration of all treated aneurysms. A distant, untreated, right frontal M2 aneurysm regressed spontaneously, after the flow was diverted away from it with the stent. The literature is reviewed, and potential pathophysiological mechanisms leading to aneurysm regression are discussed.

  20. Anastomose carótido-basilar

    Directory of Open Access Journals (Sweden)

    Ricardo Reixach-Granés

    1965-09-01

    Full Text Available O autor relata um caso de anastomose carótido-basilar por persistência da artéria trigeminal, demonstrado angiogràficamente. O paciente apresentou hemiplegia súbita e era portador de transtornos mentais de tipo deficitário. A pneumencefalografia evidenciou atrofia do parênquima cerebral do lado da anomalia.

  1. Mechanical thrombectomy in basilar artery thrombosis

    DEFF Research Database (Denmark)

    Fesl, Gunther; Holtmannspoetter, Markus; Patzig, Maximilian;

    2014-01-01

    PURPOSE: Multiple endovascular devices have been used for mechanical thrombectomy (MT) in basilar artery occlusion (BAO) for >10 years. Based on a single-center experience during the course of one decade, we present data on safety and efficacy of previous MT devices compared with modern stent ret...

  2. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

    Directory of Open Access Journals (Sweden)

    Saranat Orrapin

    2016-01-01

    Full Text Available We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity.

  3. CNS fungal meningitis to the "Top of the basilar"

    Institute of Scientific and Technical Information of China (English)

    Logan CS; Kirschner RC; Simonds GR

    2013-01-01

    Central nervous system(CNS) infections are a rare complication of epidural steroid injections and without strong clinical suspicion, fungal organisms may be overlooked among the long differential of causes of meningitis.Rare sequela of fungal meningitis is the development of stroke.To our knowledge, we present the first case of post epidural steroid injection(ESI) fungal meningitis leading toa basilar artery stroke, otherwise known as“top of the basilar” syndrome.We present a49-year-old female with a history ofESIs who presented to the emergency department with headache, neck stiffness, and abdominal pain.She was discharged after her labs and symptoms were deemed inconsistent with meningitis.She was eventually admitted and twelve days after her originalED visit, she was diagnosed with meningitis and started on anti-fungal treatment.She was discharged88 days later but was readmitted due to left sided weakness and mental status changes.She quickly lost motor and bulbar functions.AnMRA showed diminished distal flow through the basilar artery, suggesting near complete occlusion.Although appropriate long term anti-fungal treatment was started, the patient still succumbed to a rare vascular event.Physicians who are treating patients forESI meningitis should be aware of the potential for vasculitic and encephalitic complications.

  4. 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.

  5. Impending rupture of saphenous vein graft aneurysm with floating fractured bare metal stent treated by coil embolization and covered stent implantation.

    Science.gov (United States)

    Kodama, Atsuko; Kurita, Tairo; Kato, Osamu; Suzuki, Takahiko

    2016-11-01

    Aneurysmal degeneration of a saphenous vein graft (SVG) is a rare, but potentially fatal complication of coronary artery bypass graft (CABG) surgery. In this case report, a patient that had undergone prior CABG surgery and bare metal stent (BMS) implantation at the site of a stenotic SVG lesion presented at our hospital with chest pain, and an SVG aneurysm was detected at the previous BMS implantation site. In addition, the implanted BMS was fractured and floating in the SVG aneurysm. The SVG aneurysm was successfully occluded by percutaneous intervention, using a combination of distal covered stent deployment at the site of the anastomosis between the native coronary artery and the SVG and proximal coil embolization of the aneurysm.

  6. Endovascular reconstruction of aneurysms with a complex geometry

    Directory of Open Access Journals (Sweden)

    Vipul Gupta

    2016-01-01

    Full Text Available Conventional endovascular coiling remains the mainstay of treatment for most aneurysms; however, it may not be suitable for aneurysms with a complex geometry and there remains the risk of recanalization. Aneurysms with an unfavorable morphology are difficult to treat through both endovascular and surgical means. Progress in endovascular technology has allowed for the emergence of newer strategies to treat aneurysms with a complex geometry. Better packing density in wide-necked and large aneurysms can be achieved through the balloon remodeling technique. Similarly, a self-expanding stent cannot only act as a scaffold that helps to retain coils but also aids in diverting the blood flow away from the aneurysm sac. Lately, focus has shifted from endosaccular occlusion to endoluminal reconstruction; flow diverters are being increasingly used to treat aneurysms with an unfavorable geometry. However, there is no clear consensus on the best endovascular management strategy in certain subset of aneurysms - large and giant internal carotid aneurysms, blister aneurysms, and fusiform/dissecting aneurysms of the vertebrobasilar artery. We present a review of literature and discuss the current evidence for the various endovascular strategies to treat complex aneurysms.

  7. Unusual origin of the left ophthalmic artery from the basilar trunk.

    Science.gov (United States)

    Rivera, Rodrigo; Choi, In Sup; Sordo, Juan Gabriel; Giacaman, Pablo; Badilla, Lautaro; Bravo, Eduardo; Echeverria, Daniel

    2015-05-01

    The formation of the ophthalmic artery (OA) is a complex process with two different proposed embryological steps for its development. Several anatomical variants have been described. We present a very unusual origin of the ophthalmic artery from the basilar trunk, in a 45-year-old male with a history of pontine hemorrhagic stroke. MRI and CTA showed evidence of previous hemorrhage in the pons and several intracranial arterial dysplastic dilatations. DSA confirmed several fusiform dilatations of the basilar trunk. In the left ICA, no ophthalmic artery was seen arising from the carotid siphon. The left ophthalmic artery arises from the basilar trunk and runs lateral to the cavernous sinus through the middle cranial fossa, entering the left orbit at the superior orbital fissure. The patient was treated conservatively. Two main theories for this anomaly are known, one from Lasjaunias and the other from Paget. To our knowledge, this basilar origin of the OA has only been described three times in the literature. For its origin, we propose a partial persistence of the trigeminal artery together with a dominance of the dorsal ophthalmic artery.

  8. Stroke due to a fusiform aneurysm of the cervical vertebral artery: case report

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, S. [Department of Neurosurgery, Kyushu University Hospital, Fukuoka (Japan)]|[Department of Neurosurgery, Kyushu University Hospital 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-82 (Japan); Inoue, T. [Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center, Fukuoka (Japan); Haga, S.; Nishio, S.; Fukui, M. [Department of Neurosurgery, Kyushu University Hospital, Fukuoka (Japan); Kono, S. [First Department of Pathology, Kyushu University Hospital, Fukuoka (Japan); Mizushima, A. [Department of Radiology, Kyushu University Hospital, Fukuoka (Japan)

    1998-01-01

    Aneurysms of the cervical vertebral artery (VA) are uncommon; they are often caused by trauma or spontaneous dissection. A fusiform aneurysm without evidence of atherosclerosis or dissection has not been reported previously. A 46-year-old man presented with a pontine infarct. Imaging revealed a fusiform aneurysm of the left VA at the C5-6 level, with occlusion of the basilar artery. Associated minor anomalies included fusion of the vertebral bodies of C5 and C6, cervical rib and platybasia. The left VA arose directly from the aortic arch and entered the transverse foramen at the C4 level. Hyperextension and left lateral flexion of the neck caused kinking of the VA proximal to the aneurysm. Turbulent flow in the aneurysm lumen was noted on angiography. (orig.) With 4 figs., 10 refs.

  9. Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth : A Systematic Review and Meta-Analysis

    NARCIS (Netherlands)

    Backes, Daan; Rinkel, Gabriel J E; Laban, Kamil G.; Algra, Ale; Vergouwen, Mervyn D I

    2016-01-01

    BACKGROUND AND PURPOSE—: Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient- and aneurysm-specific risk factors for aneurysm growth. METHODS—: We searched EMBASE and MEDLINE for cohort studies describing

  10. Traumatic distal anterior cerebral artery aneurysm in a child : a case report.

    Directory of Open Access Journals (Sweden)

    Raju B

    2001-07-01

    Full Text Available Traumatic intracranial aneurysms constitute less than 1% of all intracranial aneurysms. A case of traumatic distal anterior cerebral artery aneurysm in 18 months old child, treated successfully by microsurgical excision of aneurysm is being reported, along with review of the literature.

  11. 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.

  12. Basilar artery migraine and reversible imaging abnormalities.

    Science.gov (United States)

    Maytal, J; Libman, R B; Lustrin, E S

    1998-01-01

    We report a case of a basilar artery migraine in a 17-year-old boy with transient CT and MR abnormalities after each of two migraine episodes. A repeat MR study 6 months after the last event showed complete resolution of the lesion. Transient abnormalities on brain images similar to those shown in our case have been reported in patients with migraine and other neurologic conditions and are most likely related to cerebral vasogenic edema.

  13. Neurofibromatosis, stroke and basilar impression: case report

    Directory of Open Access Journals (Sweden)

    PIOVESAN ELCIO JULIATO

    1999-01-01

    Full Text Available Neurofibromatosis type 1 (NF1 can virtually affect any organ, presenting most frequently with "cafe au lait" spots and neurofibromas. Vasculopathy is a known complication of NF1, but cerebrovascular disease is rare. We report the case of a 51-year-old man admitted to the hospital with a history of stroke four months before admission. On physical examination, he presented various "cafe au lait" spots and cutaneous neurofibromas. Neurologic examination demonstrated right-sided facial paralysis, right-sided hemiplegia, and aphasia. Computed tomography scan of head showed hypodense areas in the basal ganglia and centrum semiovale. Radiographs of cranium and cervical spine showed basilar impression. Angiography revealed complete occlusion of both vertebral and left internal carotid arteries, and partial stenosis of the right internal carotid artery. A large network of collateral vessels was present (moyamoya syndrome. It is an uncommon case of occlusive cerebrovascular disease associated with NF1, since most cases described in the literature are in young people, and tend to spare the posterior cerebral circulation. Basilar impression associated with this case may be considered a pure coincidence, but rare cases of basilar impression and NF1 have been described.

  14. [Gigantic aneurysm of the popliteal artery].

    Science.gov (United States)

    Fernández-Samos, R; Zorita, A; Vázquez, J G; Morán, C; Vaquero, F

    1990-01-01

    A giant popliteal aneurysm case, whose first symptom was an acute ischemia on the limb, caused by thrombosis, which was successfully treated, is reported. Although popliteal aneurysm is not a rare event, the interest of this case is focused on its extraordinary size and unique location.

  15. Transient basilar artery occlusion monitored by transcranial color Doppler presenting with a spectacular shrinking deficit: a case report

    Directory of Open Access Journals (Sweden)

    Del Sette Massimo

    2010-01-01

    Full Text Available Abstract Introduction We describe the case of a 79-year-old Caucasian Italian woman with a transient basilar occlusion monitored by transcranial Doppler, with subsequent recanalization and clinical shrinking deficit. This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. This case is important and needs to be reported because transient basilar occlusion may be easily diagnosed if transcranial Doppler is performed. Case presentation A 79-year-old woman affected by chronic atrial fibrillation and not treated with oral anticoagulants, cardioverted to sinus rhythm during a gastric endoscopy. She then showed a sudden-onset loss of consciousness, horizontal and vertical gaze palsy, tetraparesis and bilateral miosis and coma. Two hours later, the symptoms resolved quickly, leaving no residual neurologic deficits. Transcranial Doppler examination showed a dampened flow in the basilar artery in the emergency examination and a restored flow when the symptoms resolved. Conclusion This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. We believe that transcranial Doppler should be performed in all cases of unexplained acute loss of consciousness, in particular, if associated with signs of brainstem dysfunctions.

  16. Cranio-orbital approach for complex aneurysmal surgery.

    LENUS (Irish Health Repository)

    Kelleher, M O

    2012-02-03

    Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.

  17. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  18. Aneurysm in the brain

    Science.gov (United States)

    ... aneurysms Medical problems such as polycystic kidney disease , coarctation of the aorta , and endocarditis High blood pressure, ... Read More Aneurysm Brain aneurysm repair Brain surgery Coarctation of the aorta Endovascular embolization Epilepsy - overview Incidence ...

  19. Very late stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-necked aneurysm.

    Science.gov (United States)

    Lee, Chang-Young; Kim, Chang-Hyun

    2015-02-01

    The crossing Y-stent technique is a viable option for coiling of wide-necked bifurcation aneurysms. However, little is known about the long-term impact of this technique. Very late (>1 year) stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-necked basilar tip aneurysm, which has not been reported to date, is described.

  20. Surgical repair of an aberrant splenic artery aneurysm: report of a case.

    Science.gov (United States)

    Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

    2007-03-01

    Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

  1. Hipnoticos corticales y basilares y acciones anticonvulsivantes

    Directory of Open Access Journals (Sweden)

    Carlos Gutiérrez-Noriega

    1943-06-01

    Full Text Available Se estudian las diferencias de los hipnóticos corticales y basilares desde el punto de vista de sus acciones anticonvulsivantes. Los resultados son los siguientes: 1. Los hipnóticos del grupo basilar (barbitúrico y uretano poseen un poder anticonvulsivante considerablemente mayor que los hipnóticos del grupo cortical (alcoholes, aldehidos, bromuros, éter, con excepción del sulfato de magnesia, clasificado en el grupo subcortical, que tiene muy poca acción anticonvulsivante. 2. Algunos hipnóticos del grupo cortical (cloralosa disminuyen notablemente a dosis narcótica el umbral para las convulsiones clónicas, producidas por el cardiazol, coramina y estricnina; pero aumentan el umbral para las convulsiones tónicas. Estos hipnóticos actúan paradójicamente, como anticonvulsivantes y como sinergistas de los convulsivantes. 3. El sinergismo de cardiazol y estricnina para producir convulsiones clónicas es mucho más notable durante la narcosis por cloralosa que en el animal no anestesiado. 4. Existen significativas diferencias cualitativas y cuantitativas entre las convulsiones del animal no anestesiado y las convulsiones del animal durante la narcosis por cloralosa. En este último caso no se produce la reacción tónica, las reacciones neurovegetativas son más débiles, pero la duración de las convulsiones clónicas es considerablemente mayer. 5. Las diferencias de actividad anticonvulsivante observadas entre los dos grupos de hipnóticos, no pueden ser tomadas como prueba de la clasificación topográfica (córtico-basilar. Al contrario, sugieren que algunos hipnóticos del grupo cortical deben su típica manera de actuar a una acción estimulante tanto sobre la corteza cerebral como sobre los centros subcorticales. Se discute la posibilidad de que el sistema internuncial sea el que principalmente se estimula. Así, mientras que en la narcosis de tipo barbitúrico disminuye la excitabilidad de todo el sistema nervioso de relaci

  2. Mechanics of the basilar membrane in Caiman crocodilus.

    Science.gov (United States)

    Wilson, J P; Smolders, J W; Klinke, R

    1985-04-01

    Vibration measurements were made at a number of positions near the proximal (basal) end of the basilar membrane, and on the columella footplate, of Caiman crocodilus using a capacitive probe. The measurements established the existence of a mechanical travelling wave in this species. They showed no significant change of mechanical tuning with temperature, and were highly significantly different from previous reports of neural temperature sensitivity (Smolders, J. and Klinke, R. (1984): J. Comp. Physiol. 155, 19-30). Thus the neural sensitivity to temperature change appears not to depend upon basilar membrane mechanics. One interpretation of this is that the basilar membrane passively precedes an active temperature-sensitive filter. It was also found that the limbus supporting the basilar membrane had a measurable, but unturned, vibration and that the effect of draining scala tympani for the measurements was to increase the basilar membrane tuning frequency by a factor of about 1.5.

  3. RESULTS OF THE USE OF PEEK CAGES IN THE TREATMENT OF BASILAR INVAGINATION BY GOEL TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Luís Eduardo Carelli Teixeira da Silva

    2016-03-01

    Full Text Available ABSTRACT Objective: Analysis of the use of polyetheretherketone (PEEK cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.

  4. Contractile responses to rat urotensin II in resting and depolarized basilar arteries.

    Science.gov (United States)

    Porras-González, Cristina; Ureña, Juan; Egea-Guerrero, Juan José; Gordillo-Escobar, Elena; Murillo-Cabezas, Francisco; González-Montelongo, María del Carmen; Muñoz-Sánchez, María Angeles

    2014-03-01

    The effects of human urotensin II (hUII) on the vascular tone of different animal species has been studied extensively. However, little has been reported on the vasoactive effects of rat urotensin (rUII) in murine models. The aim of the present study was to investigate the effects of rUII on vasoreactivity in rat basilar arteries. Basilar arteries from adult male Wistar rats (300-350 g) were isolated, cut in rings, and mounted on a small vessel myograph to measure isometric tension. rUII concentrations were studied in both resting and depolarized state. To remove endothelial nitric oxide effects from the rUII response, we treated selected arterial rings with Nω-nitro-L-arginine methyl ester (L-NAME). 10 μM rUII produced a potent vasoconstrictor response in rat basilar arteries with intact endothelium, while isometric forces remained unaffected in arterial rings treated with lower rUII concentrations. Although L-NAME did not have a significant effect on 10 μM rUII-evoked contraction, it slightly increased arterial ring contraction elicited by 1 μM rUII. In depolarized arteries, dose-dependent rUII increased depolarization-induced contractions. This effect was suppressed by L-NAME. Our results show that the rat basilar artery has a vasoconstrictor response to rUII. The most potent vasoconstrictor effect was produced by lower doses of rUII (0.1 and 1 μM) in depolarized arteries with intact endothelium. This effect could facilitate arterial vasospasm in vascular pathophysiological processes such as subarachnoid hemorrhage and hypertension, when sustained depolarization and L-type Ca(2+) channel activation are present.

  5. Simultaneous presentation of two cerebral aneurysms.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Sasaki, Kazuto; Chonan, Masashi; Mino, Masaki

    2012-01-01

    A 48-year-old woman experienced sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage (SAH) and intracerebral hematoma in the right frontal lobe. Digital subtraction angiography revealed three aneurysms in the anterior communicating artery (AcomA), the right posterior communicating artery (PcomA), and the right middle cerebral artery. The AcomA aneurysm was treated with endovascular coiling. However, her oculomotor nerve palsy was aggravated after the procedure. Embolization of the right PcomA aneurysm was conducted immediately and her oculomotor nerve palsy recovered completely 3 months later. Simultaneous presentation of multiple aneurysms with separate symptoms is rare. We speculate that the progressive oculomotor nerve palsy was caused by tiny enlargement or morphological change of the aneurysm caused by elevated blood pressure and pulsatile effect after SAH.

  6. 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.

  7. Basilar artery of the capybara (Hydrochaeris hydrochaeris): an ultrastructural study.

    Science.gov (United States)

    Islam, S; Ribeiro, A A C M; Loesch, A

    2004-04-01

    The present study investigated the ultrastructural features of the basilar artery of the largest rodent species, the capybara. The study suggests that the general ultrastructural morphological organization of the basilar artery of the capybara is similar to that of small rodents. However, there are some exceptions. The basilar artery of the capybara contains a subpopulation of 'granular' vascular smooth muscle cells resembling monocytes and/or macrophages. The possibility cannot be excluded that the presence of these cells reflects the remodelling processes of the artery due to animal maturation and the regression of the internal carotid artery. To clarify this issue, more systemic studies are required involving capybaras of various ages.

  8. Trigeminal neuralgia secondary to basilar impression: A case report

    Science.gov (United States)

    de Almeida Holanda, Maurus Marques; Pereira Neto, Normando Guedes; de Moura Peixoto, Gustavo; Pinheiro Santos, Rayan Haquim

    2015-01-01

    We report a rare case of trigeminal neuralgia. A 23-year-old woman with a history of 1 year of typical trigeminal neuralgia manifested the characteristics of basilar impression. Magnetic resonance imaging (MRI) demonstrated basilar impression, deformity of the posterior fossa with asymmetry of petrous bone, and compression of medulla oblongata in the topography of the odontoid apophysis. The operation was performed through a suboccipital craniectomy. The neuralgia disappeared after surgery and remains completely resolved until today. This is the second reported case of trigeminal neuralgia in a patient with basilar impression in Brazil. PMID:25972713

  9. Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

    Science.gov (United States)

    Cho, Young Dae; Rhim, Jong Kook; Yoo, Dong Hyun; Kang, Hyun-Seung; Kim, Jeong Eun; Han, Moon Hee

    2017-01-01

    Objective Stents are widely used in coil embolization of intracranial aneurysms, but on occasion, a microcatheter must traverse a stented segment of artery (so-called trans-cell technique) to select an aneurysm, or double stenting may necessary. In such situations, microguidewire passage and microcatheter delivery through a tortuous stented parent artery may pose a technical challenge. Described herein is a microguidewire looping technique to facilitate endovascular navigation in these circumstances. Methods To apply this technique, the microguidewire tip is looped before entering the stented parent artery and then advanced distally past the stented segment, with the loop intact. Rounding of the tip prevents interference from stent struts during passage. A microcatheter is subsequently passed into the stented artery for positioning near the neck of aneurysm, with microguidewire assistance. The aneurysm is then selected, steering the microcatheter tip (via inner microguidewire) into the dome. Results This technique proved successful during coil embolization of nine saccular intracranial aneurysms (internal carotid artery [ICA], 6; middle cerebral artery, 2; basilar tip, 1), performing eight trans-cell deliveries and one additional stenting. Selective endovascular embolization was enabled in all patients, resulting in excellent clinical and radiologic outcomes, with no morbidity or mortality directly attributable to microguidewire looping. Conclusion Microguidewire looping is a reasonable alternative if passage through a stented artery is not feasible by traditional means, especially at paraclinoid ICA sites. PMID:28264249

  10. A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

    Directory of Open Access Journals (Sweden)

    Katleen Devue

    2014-01-01

    Full Text Available This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

  11. The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?

    Science.gov (United States)

    Caliandro, Pietro; Reale, Giuseppe; Tartaglione, Tommaso; Rossini, Paolo Maria

    2016-07-01

    We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.

  12. Intracranial aneurysms in twins: case report and review of the literature.

    Science.gov (United States)

    Leung, H K; Lam, Y; Cheng, K M; Chan, C M; Cheung, Y L

    2011-04-01

    Intracranial aneurysm in twins is a rare clinical disease entity. Only 15 cases have been described in the literature. We report on a pair of identical twins with intracranial aneurysms. One presented with subarachnoid haemorrhage; digital subtraction angiography showed a left posterior communicating artery aneurysm, which was treated by coiling. The patient's twin sister was called for screening, whereupon digital subtraction angiography revealed a right ophthalmic internal carotid artery aneurysm that was treated conservatively.

  13. Transcatheter Coil Embolization of an Arc of Buhler Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Su Jin; Lim, Nam Yeul; Choi, Soo Jin Nah; Kim, Jae Kyu; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam National University Hospital, Gwangju (Korea, Republic of); Jang, Nam Kyu [Hwasun Chonnam National University Hospital, Hwasun (Korea, Republic of)

    2008-07-15

    We report the findings of a patient with an asymptomatic Arc of Buhler (AOB) aneurysm, which was successfully treated by transcatheter coil embolization. An abdominal CT and angiography revealed an intact pancreaticoduodenal artery arcade (PDAA) and an anomalous communication between the SMA and celiac axis, termed an AOB. An aneurysm was observed at the origin of the AOB and treated with a transcatheter embolization using coils. A follow-up CT imaging confirmed the total occlusion of the aneurysm with a patent PDAA. The successful results of this treatment suggest that the endovascular therapy of an AOB aneurysm with a celiac axis occlusion and an intact PDAA is feasible and safe.

  14. Flow diversion for complex intracranial aneurysms in young children.

    Science.gov (United States)

    Navarro, Ramon; Brown, Benjamin L; Beier, Alexandra; Ranalli, Nathan; Aldana, Philipp; Hanel, Ricardo A

    2015-03-01

    Pediatric intracranial aneurysms are exceedingly rare and account for less than 5% of all intracranial aneurysms. Open surgery to treat such aneurysms has been shown to be more durable than endovascular techniques, and durability of treatment is particularly important in the pediatric population. Over the past 2 decades, however, a marked shift in aneurysm treatment from open surgery toward endovascular procedures has occurred for adults. The authors describe their early experience in treating 3 unruptured pediatric brain aneurysms using the Pipeline embolization device (PED). The first patient, a girl with Majewski osteodysplastic primordial dwarfism Type II who was harboring multiple intracranial aneurysms, underwent two flow diversion procedures for a vertebrobasilar aneurysm and a supraclinoid internal carotid artery aneurysm. The second patient underwent PED placement on a previously coiled but enlarging posterior communicating artery aneurysm. All procedures were uneventful, with no postsurgical complications, and led to complete angiographic obliteration of the aneurysms. To the authors' knowledge, this is the first series of flow diversion procedures in children reported in the medical literature. While flow diversion is a new and relatively untested technology in children, outcomes in adults have been promising. For challenging lesions in the pediatric population, flow diversion may have a valuable role as a well-tolerated, safe treatment with durable results. Many issues remain to be addressed, such as the durability of flow diverters over a very long follow-up and vessel response to growth in the presence of an endoluminal device.

  15. Endovascular treatment of posterior cerebral artery aneurysms using detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Hong Gee [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Konkuk University Hospital, Department of Radiology, Seoul (Korea); Kim, Sam Soo; Han, Heon [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Kang, Hyun-Seung [Konkuk University Hospital, Department of Neurosurgery, Seoul (Korea); Moon, Won-Jin [Konkuk University Hospital, Department of Radiology, Seoul (Korea); Byun, Hong Sik [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2008-03-15

    Aneurysms of the posterior cerebral artery (PCA) are rare, and most of the studies reported in the literature in which the endovascular approach was applied were carried out on a limited number of patients with PCA aneurysms. We retrospectively reviewed our cases of PCA aneurysms - at various locations and of differing shapes - that received endovascular treatment and evaluated the treatment outcome. From January 1996 to December 2006, 13 patients (eight females and five males) with 17 PCA aneurysms (nine fusiform and eight saccular) were treated using the endovascular approach. The age of the patients ranged from 20 to 67 years, with a mean age of 44 years. Of the 13 patients, ten presented with intracranial hemorrhage, and one patient, with a large P2 aneurysm, presented with trigeminal neuralgia; the aneurysms were asymptomatic in the remaining two patients. All 13 patients were successfully treated, with only one procedure-related symptomatic complication. Seven patients were treated by occlusion of the aneurysm and parent artery together; five patients, by selective embolization of the aneurysm; one patient, by partial coiling. Although infarctions were found in two patients treated with selective embolization and in three patients treated with parent artery occlusion, only one patient with a ruptured P2 aneurysm treated with parent artery occlusion developed transient amnesia as an ischemic symptom. Posterior cerebral artery aneurysms can be treated safely with either occlusion of the aneurysm together with the PCA or with a selective coil embolization. Infarctions may occur after endovascular treatment, but they are rarely the cause of a disabling symptom. (orig.)

  16. Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient: A Case Report

    OpenAIRE

    Shin, S H; Choi, I.S.; Thomas, K.; David, C.A.

    2013-01-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The pati...

  17. Splenic Artery Aneurysm Presenting as Extrahepatic Portal Vein Obstruction: A Case Report

    Directory of Open Access Journals (Sweden)

    T. P. Elamurugan

    2011-01-01

    Full Text Available Splenic artery aneurysms are the most common visceral aneurysm occuring predominantly in females. They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension. Splenic artery aneurysm causing extrahepatic portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. We report one such rare presentation of splenic artery aneurysms in a pregnant female with the features of EHPVO (variceal bleed, hypersplenism treated by splenectomy along with excision of the aneurysm.

  18. Endovascular Treatment of Multiple HIV-related Aneurysms Using Multilayer Stents

    Energy Technology Data Exchange (ETDEWEB)

    Euringer, Wulf [University Hospital Freiburg, Department of Diagnostic Radiology (Germany); Suedkamp, Michael; Rylski, Bartosz [University Hospital Freiburg, Department of Cardiovascular Surgery (Germany); Blanke, Philipp, E-mail: philipp.blanke@uniklinik-freiburg.de [University Hospital Freiburg, Department of Diagnostic Radiology (Germany)

    2012-08-15

    Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months' follow-up.

  19. Microcatheter looping to facilitate aneurysm selection in coil embolization of paraclinoid aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Rhim, Jong Kook; Park, Jeong Jin; Jeon, Jin Sue; Yoo, Roh Eul; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-08-15

    Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy. This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment. Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping. This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

  20. "Microbleeding" from intracranial aneurysms: Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Eric S Nussbaum

    2014-01-01

    Full Text Available Background: During elective surgery for unruptured aneurysms, we have identified a group of patients with hemosiderin staining of the pial surface immediately adjacent to the aneurysm dome suggesting a remote and unrecognized history of microbleeding from the aneurysm. These cases form the basis for this report. Methods: Medical records of 421 unruptured cerebral aneurysm patients treated surgically between January 2003 and September 2010 were retrospectively reviewed. Patients with a history of prior subarachnoid hemorrhage, craniotomy, or significant closed head injury were excluded from review. Records were reviewed for intraoperative descriptions of hemosiderin deposition in the vicinity of the aneurysm as well as history of headaches, time to presentation, comorbidities, aneurysm characteristics, procedures, and radiologic imaging. Results: Local hemosiderin staining immediately adjacent to the aneurysm was identified intraoperatively in 13 cases. Each of these patients had a history of remote atypical headache prior to presentation. Eight of these patients (62% had aneurysms described as particularly "thin-walled" at the time of surgery. Aneurysm locations included the internal carotid artery (ICA (54%, middle cerebral artery (MCA (23%, anterior communicating artery (ACOMMA (15%, and the anterior cerebral artery (ACA (8%. More than half (54% of these patients had a history of smoking, while 31% had hypertension, and 23% had a history of alcohol abuse. Dyslipidemia and family history of aneurysms were present in 15% and hypercholesterolemia was noted in one patient (8%. Conclusion: We suggest this group of patients had suffered a "microbleed" resulting in local hemosiderin deposition next to the aneurysm. The origins and clinical implications of such microbleeds are unknown and warrant further investigation.

  1. 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.

  2. Intracranial aneurysm growth quantification in CTA

    Science.gov (United States)

    Firouzian, Azadeh; Manniesing, Rashindra; Metz, Coert T.; Klein, Stefan; Velthuis, Birgitta K.; Rinkel, Gabriel J. E.; van der Lugt, Aad; Niessen, Wiro J.

    2012-02-01

    Next to aneurysm size, aneurysm growth over time is an important indicator for aneurysm rupture risk. Manual assessment of aneurysm growth is a cumbersome procedure, prone to inter-observer and intra-observer variability. In clinical practice, mainly qualitative assessment and/or diameter measurement are routinely performed. In this paper a semi-automated method for quantifying aneurysm volume growth over time in CTA data is presented. The method treats a series of longitudinal images as a 4D dataset. Using a 4D groupwise non-rigid registration method, deformations with respect to the baseline scan are determined. Combined with 3D aneurysm segmentation in the baseline scan, volume change is assessed using the deformation field at the aneurysm wall. For ten patients, the results of the method are compared with reports from expert clinicians, showing that the quantitative results of the method are in line with the assessment in the radiology reports. The method is also compared to an alternative method in which the volume is segmented in each 3D scan individually, showing that the 4D groupwise registration method agrees better with manual assessment.

  3. Abdominal aortic aneurysm

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  4. Vascular plug for ICA occlusion in cavernous carotid aneurysms: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Scott, David A.; Keston, Peter; White, Philip; Sellar, Robin [Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom)

    2008-09-15

    Large, symptomatic aneurysms of the cavernous internal carotid artery (ICA) can be successfully treated by a combination of aneurysm coiling and occlusion of the parent vessel. We describe the use of an Amplatzer (AGA medical corporation, Plymouth, MA, USA) detachable nitinol vascular plug to occlude the ICA in four patients with symptomatic cavernous ICA aneurysms. (orig.)

  5. Traumatic intracranial aneurysm in the clinoid segment of the internal carotid artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Jung; Kim, Hyun Sook; Jeong, Yoon Young; Choi, Yun Sun; Kang, Hee In [Eulji Hospital/Eulji Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    Traumatic aneurysms need an accurate diagnosis and active treatment because they present the risk of rupturing within a week after trauma in 50% of cases. We report a traumatic aneurysm arising from the medial wall of the clinoid segment of the internal carotid artery. The aneurysm was observed on a CT angiography and a transfemoral cerebral angiography and treated successfully with endovascular stent deployment.

  6. The Therapeutic Effect of Vertebral-basilar Artery Insufficiency by Treating with Erigeron Brevisca-pus and Betahistine and Its Impact on the Indexes of Vascular Endothelial Function%灯盏细辛联合倍他司汀对椎-基底动脉供血不足的疗效及血管内皮功能指标变化

    Institute of Scientific and Technical Information of China (English)

    易蕾; 雷蕾; 杜丹心; 张明洁

    2015-01-01

    目的::回顾性分析灯盏细辛+倍他司汀治疗椎-基底动脉供血不足(VBI)的临床疗效及对患者血管内皮功能指标血浆内皮素-1(ET-1)、血管性血友病因子(vWF)和血清一氧化氮(NO)水平的影响。方法:140例临床确诊 VBI 患者,按随机数字表法分为治疗对照组(n=70,采用倍他司汀片治疗)和联合治疗组(n=70,采用灯盏细辛注射液+倍他司汀片治疗)。治疗14天后,观察比较两组临床疗效以及 ET-1、vWF 和 NO 水平变化和组间差异。结果:联合治疗组显效率及总有效率分别为71.42%和91.43%,明显优于治疗对照组的45.71%和78.57%(P 0.05)。两组治疗期间均未发生脑及其它脏器出血等药物不良反应。结论:灯盏细辛+倍他司汀能显著改善 VBI 患者血管内皮功能,提高临床疗效。%Objective:To analysis of the therapeutic effect to vertebral-basilar artery insufficiency (VBI)pa-tients by treating with erigeron breviscapus and betahistine,and then observe its impact on the levels of endothelin-1 (ET-1),von willebrand factor (vWF)and nitrogen monoxide (NO).Method:140 cases of clinically diagnosed pa-tients with VBI were divided into control treatment group (n = 70,only treated with betahistine)and combined treatment group (n=70,treated with a combination therapy of erigeron breviscapus and betahistine)according to the random number table.The therapeutic effect after 14-days'treatment and the levels of ET-1,vWF and NO of the 140 patients were detected.Results:After treatment,the significant efficiency and total effective efficiency of the combined treatment group were 71.42% and 91.43% respectively,which were apparently superior to 45.71% and 78.57% of the control treatment group (P 0.05).There was not any bleeding in patients'brains or other organs during the treatments.Conclusion:Erigeron breviscapus combined with betahistine treatment can make significant improvements in VBI patients’vascular endothelial function

  7. 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.

  8. Stent-assisted coil embolization of a recurrent posterior cerebral artery aneurysm following surgical clipping.

    Science.gov (United States)

    Takeshita, Tomonori; Nagamine, Tomoaki; Ishihara, Kohei; Kaku, Yasuhiko

    2017-02-01

    Posterior cerebral artery (PCA) aneurysms are rare, and direct surgery of these is considered difficult. Coil embolization of PCA aneurysms is becoming popular. However, it is difficult to completely obliterate the aneurysm while preserving the flow of the parent artery in large or giant PCA aneurysms with a wide neck with this technique. We report a case of a large and wide-necked PCA aneurysm with multiple recurrences following successful surgical clipping and coil embolization. A 77-year-old man with a large unruptured right PCA (P2) aneurysm was successfully treated by surgical clipping. Postoperative digital subtraction angiography (DSA) showed complete aneurismal occlusion. Four years afterward, the aneurysm recurred and grew toward the contralateral. Surgical retreatment of this complicated aneurysm was considered difficult, with a substantial risk of complications. Therefore, the aneurysm was treated with an endovascular procedure. Because simple coil embolization was not expected to achieve satisfactory obliteration of the aneurysm with preservation of parent artery patency, we used stent-assisted coil embolization. The patient tolerated the treatment well. On DSA obtained six months after the first endovascular treatment, coil compaction and recanalization of the aneurysm were detected. A second coil embolization was successfully performed without any complications. The aneurysm was stable during the next six-month follow-up. Stent-assisted coil embolization may be feasible and effective for such postoperatively complicated aneurysms.

  9. Paediatric intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    A A Wani

    2006-01-01

    Full Text Available Intracranial aneurysms in childhood account for 1-2% of intracranial aneurysms.[1],[2] These aneurysms have unique characteristics that make them different from those in adults. These differences are evident in their epidemiology, location, clinical spectrum, association with trauma and infection, complications and outcome.

  10. Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter.

    Science.gov (United States)

    Burrows, Anthony M; Zipfel, Gregory; Lanzino, Giuseppe

    2012-11-15

    Pediatric patients with aneurysm often have different localizations and morphologies from adults and recurrences are not uncommon after successful clip reconstruction/obliteration. Treatment of a recurrent pediatric aneurysm after clip ligation is a technical challenge. We present the case of an adolescent with a middle cerebral artery (MCA) fusiform aneurysm which recurred following clip reconstruction and bypass. The aneurysm was successfully treated with endovascular flow diversion.

  11. Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter

    OpenAIRE

    Burrows, Anthony M.; Zipfel, Gregory; Lanzino, Giuseppe

    2012-01-01

    Pediatric patients with aneurysm often have different localizations and morphologies from adults and recurrences are not uncommon after successful clip reconstruction/obliteration. Treatment of a recurrent pediatric aneurysm after clip ligation is a technical challenge. We present the case of an adolescent with a middle cerebral artery (MCA) fusiform aneurysm which recurred following clip reconstruction and bypass. The aneurysm was successfully treated with endovascular flow diversion.

  12. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion.

    Science.gov (United States)

    Johnson, Andrew K; Tan, Lee A; Lopes, Demetrius K; Moftakhar, Roham

    2016-03-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail.

  13. Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter.

    Science.gov (United States)

    Burrows, Anthony M; Zipfel, Gregory; Lanzino, Giuseppe

    2013-11-01

    Pediatric patients with aneurysm often have different localizations and morphologies from adults and recurrences are not uncommon after successful clip reconstruction/obliteration. Treatment of a recurrent pediatric aneurysm after clip ligation is a technical challenge. We present the case of an adolescent with a middle cerebral artery (MCA) fusiform aneurysm which recurred following clip reconstruction and bypass. The aneurysm was successfully treated with endovascular flow diversion.

  14. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection.

    Science.gov (United States)

    Blanco Amil, Carla Lorena; Vidal Rey, Jorge; López Arquillo, Irene; Pérez Rodríguez, María Teresa; Encisa de Sá, José Manuel

    2016-05-01

    Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.

  15. [Inflammatory aneurysms of the abdominal aorta].

    Science.gov (United States)

    Tovar Martín, E; Acea Nebril, B

    1993-01-01

    Approximately 10 per cent of abdominal aneurysms have an excessively thick wall that sometimes involve duodenum, cava or colon by an inflammatory process. Between February 1986 and December 1992, 147 patients with abdominal aortic aneurysm (AAA) were treated surgically and in 13 (8.8%) the aneurysms were found to be inflammatory. Their mean age was 67.3 years (70.1 years in non inflammatory group) and all were symptomatics initially (abdominal pain in 53%, rupture in 23%, mass in 15%). The operative mortality for elective resection was 37% in patients with inflammatory abdominal aortic aneurysms (IAAA) decreasing to 9% in the AAA group without inflammatory involvement. We conclude that surgery is indicated in these patients to prevent rupture and to hasten the subsidense of inflammatory process ever with postoperative morbi-mortality increased.

  16. Endovascular exclusion of a large external iliac vein aneurysm.

    Science.gov (United States)

    Todorov, Mina; Hernandez, Diego

    2013-07-01

    Iliac vein aneurysms are uncommon, and there is no consensus on optimal treatment. We present a case of venous exclusion using an endovascular approach. To our knowledge, this is the first reported case of a large external iliac vein aneurysm treated endovascularly. We have demonstrated the feasibility of this approach with satisfactory 1-year follow-up.

  17. Streptococcus pyogenes aortic aneurysm infection: forgotten but not gone

    Directory of Open Access Journals (Sweden)

    Bradley J. Gardiner

    2013-11-01

    Full Text Available Historically, Streptococcus pyogenes was a common cause of endocarditis and infected aortic aneurysm. Today, endovascular infections due to this organism have become exceedingly rare. We report the first case of aortic aneurysm infection due to S. pyogenes treated with initial endoluminal repair, review previous reports and discuss current treatment options.

  18. Traumatic aneurysm of superficial temporal artery. CT demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, A.; Tyagi, G.; Sahai, A.; Baijal, S.S. (G.B. Pant Hospital and M.A. Medical Coll., New Delhi (India). Dept. of Neurosurgery G.B. Pant Hospital and M.A. Medical Coll., New Delhi (India). Dept. of Radiology)

    1991-12-01

    A case of traumatic pseudo-aneurysm of the superficial temporal artery documented on Computed tomography (CT) and angiography is described in a 55-year-old female, who was treated by surgical excision. Computed tomographic appearance of this lesion is illustrated. This represents, to our knowledge, the first CT demonstration of traumatic aneurysm of superficial temporal artery within a large subgaleal haematoma. (orig.).

  19. Individualized management for intracranial vertebral artery dissecting aneurysms

    Directory of Open Access Journals (Sweden)

    SHANG Yan-guo

    2012-02-01

    Full Text Available Objective To discuss the individualized management strategy for intracranial vertebral artery dissecting aneurysms. Methods Eighteen patients with intracranial vertebral artery dissecting aneurysms were treated with different surgical methods. Results Eighteen patients underwent different surgical treatment. Five patients underwent complete occlusion of the aneurysm and parent artery by coiling, 5 were treated by stent -assisted coiling (3 densely packed coiling and 2 non-densely packed coiling, 4 underwent stent-only therapy and 3 of them presented hemodynamic improvement after surgery, 3 were treated by direct surgical clipping, and 1 underwent occipital artery-posterior inferior cerebellar artery bypass. Two aneurysms ruptured immaturely, in which one patient died on the third day after operation and one patient occurred moderate disablity. Only 1 patient who underwent complete occlusion of aneurysm and parent artery presented temporarily ischemic symptoms. No adverse effects were seen in other patients. Seventeen patients were followed up for 1 month to 3 years, and all the aneurysms were stable. Conclusion There are many kinds of therapeutic methods for intracranial vertebral artery dissecting aneurysms. The patients should be treated according to several factors such as the clinical manifestations, aneurysm configuration, and relationship with the posterior inferior cerebellar artery. The treatment should be individualized.

  20. Talk to Your Doctor about Abdominal Aortic Aneurysm

    Science.gov (United States)

    ... Topic En español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics Overview What is AAA? ... ask your doctor about getting screened (tested) for abdominal aortic aneurysm (AAA). If AAA isn't found and treated ...

  1. Juxtarenal Mycotic Aneurysm as a Complication of Acute Exacerbation of Chronic Cholecystitis Treated by Resection and Replacement by a Fresh Allograft.

    Science.gov (United States)

    Grus, Tomáš; Lambert, Lukáš; Rohn, Vilém; Klika, Tomáš; Grusová, Gabriela; Michálek, Pavel

    2016-01-01

    We present a case of a female patient with infectious (mycotic) juxtarenal abdominal aneurysm with atypical symptoms beginning as acute exacerbation of chronic cholecystitis. Apart from common antibiotic treatment, the patient successfully underwent resection of the diseased segment and replacement by a fresh allograft in order to reduce the risk of infection of the graft, but with the need of subsequent life-long immunosuppressive therapy. Perioperative monitoring of the spinal cord by near infrared spectroscopy was used to identify possible spinal ischemia. The choice of the fresh allograft was based on our experience supported by review of the literature.

  2. 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.

  3. Pediatric isolated bilateral iliac aneurysm.

    Science.gov (United States)

    Chithra, R; Sundar, R Ajai; Velladuraichi, B; Sritharan, N; Amalorpavanathan, J; Vidyasagaran, T

    2013-07-01

    Aneurysms are rare in children. Isolated iliac artery aneurysms are very rare, especially bilateral aneurysms. Pediatric aneurysms are usually secondary to connective tissue disorders, arteritis, or mycotic causes. We present a case of a 3-year-old child with bilateral idiopathic common iliac aneurysms that were successfully repaired with autogenous vein grafts.

  4. Delayed onset of fatal basilar thrombotic embolus after whiplash injury

    DEFF Research Database (Denmark)

    Viktrup, L; Knudsen, G M; Hansen, S H

    1995-01-01

    BACKGROUND: Whiplash injuries are generally seen after rear-end rather than frontal car collisions. Previous reports have documented death up to 8 days after serious whiplash injury. We report a case of lethal basilar thrombotic embolus that occurred 2 months after the patient's injury...... in a collision. CASE DESCRIPTION: After whiplash trauma in a car accident, a 50-year-old taxi driver suffered from headache and episodic visual disturbances. Two months after the accident he suddenly lost consciousness and was admitted to the hospital. A CT scan performed at that time was indicative of basilar...... thrombosis. The patient died 3 days later. The autopsy revealed a thrombosis in the right vertebral artery and a thrombotic embolus in the basilar artery. Microscopically, a lesion of the right vertebral artery was found at the level of the atlantoaxial joint. CONCLUSIONS: We conclude that the whiplash...

  5. Microscopic anatomy of the human vertebro-basilar system

    Directory of Open Access Journals (Sweden)

    Renato P. Chopard

    1991-12-01

    Full Text Available Concerning the structure of connective-muscular components the authors studied the walls of the terminal segments of the vertebral arteries as well as the basilar artery, utilizing the following staining methods: Azan modified by Heideinheim, Weigert's resorcin-fuchsin, and Weigert modified by van Gieson. It was established that wall of the vertebro-basilar system exhibits a mixed structure, muscular and elastic, by means of which the vessels are adjusted to the specific blood circulation conditions. Thus, vertebral arteries show in the most external layer of tunica media an evident external elastic lamina. In contrast, in the basilar artery the elastic tissue is localized mainly in the tunica media, and is distributed heterogeneously. In its caudal segment the elastic fibers are situated in the most internal layer of tunica media, and in the cranial segment the elastic component is homogenously distributed in the whole of tunica media.

  6. Primary stenting as emergency therapy in acute basilar artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Spreer, Joachim; Arnold, Sebastian; Klisch, Joachim; Schumacher, Martin [Section of Neuroradiology, University Hospital Freiburg, Breisacher Strasse 64, 79106 Freiburg (Germany); Els, Thomas; Hetzel, Andreas; Huppertz, Hans-Juergen; Oehm, Eckhardt [Department of Neurology, University Hospital Freiburg, Freiburg (Germany)

    2002-09-01

    In three patients with acute occlusion of the basilar artery intra-arterial fibrinolysis resulted in only partial recanalization and revealed severe stenosis as the underlying cause. Application of micro-stents without previous dilatation resulted in vessel re-opening. Two patients had an excellent clinical outcome. One patient died 10 days after the stroke due to brainstem infarction. Emergency primary stent application may improve the outcome in acute basilar artery occlusion, if intra-arterial thrombolysis fails to re-establish a sufficient flow. (orig.)

  7. Middle meningeal artery arising from the basilar artery.

    Science.gov (United States)

    Salem, Mohamed M; Fusco, Matthew R; Dolati, Parviz; Reddy, Arra S; Gross, Bradley A; Ogilvy, Christopher S; Thomas, Ajith J

    2014-12-01

    Various anomalies for the origin of the middle meningeal artery (MMA) have been described in the literature. However, origin of the MMA from the basilar trunk is an extremely rare variant. We report on a 54-year-old female who presented with frequent headaches; magnetic resonance imaging showed a right parietal meningioma. The abnormal origin of the middle meningeal artery from the basilar artery was diagnosed by angiography performed for preoperative embolization of the tumor. We report on the case with a review of the embryologic basis, possible explanations for this aberrant origin, and its clinical implications.

  8. Long-term MRI findings of patients with embolized cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Pyysalo, Liisa M.; Niskakangas, Tero T.; Oehman, Juha E. (Tampere Univ. Hospital, Dept. of Neurosurgery, Tampere (Finland)), email: liisa.pyysalo@uta.fi; Keski-Nisula, Leo H.; Kaehaerae, Veikko J. (Medical Imaging Center, Tampere (Finland))

    2011-02-15

    Background: Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. Parenchymal infarctions related to aneurysms have mostly been studied in patients with subarachnoidal hemorrhage (SAH) but infarction rates in patients with endovascularly treated unruptured aneurysms have been little studied. Purpose: To determine the frequency of permanent parenchymal lesions as detected in magnetic resonance imaging (MRI) in patients treated with endovascular coiling and to assess aneurysm-related infarctions after the initial treatment period. Material and Methods: A total of 64 patients (32 with primarily ruptured aneurysms) with 69 embolized aneurysms were examined neurologically and by MRI and magnetic resonance angiography (MRA) more than 9 years after the initial endovascular treatment. Results: A total of 14 out of 32 (44%) SAH patients and 11 (34%) patients with unruptured aneurysms had parenchymal lesions in MRI. Infarctions were detected in 10 (31%) SAH patients and the majority (9/10, 90%) of them were aneurysm-related. All aneurysm-related infarctions were detected at the acute hospitalization stage. A total of six (55%) out of 11 infarctions in patients with unruptured aneurysms were aneurysm-related and two of them appeared after the treatment period. Patients with infarction had poorer clinical outcome than patients with no ischemic lesions in MRI. Conclusion: Nineteen percent of patients with unruptured and 41% with ruptured aneurysms had aneurysmrelated parenchymal lesions in MRI. Most of these were detected during acute treatment period. Aneurysmrelated infarctions after treatment period are uncommon

  9. Microsurgical subtemporal approach to aneurysms on the P 2 segment of the posterior cerebral artery

    Directory of Open Access Journals (Sweden)

    Zhitao Jing

    2010-01-01

    Full Text Available Background: Aneurysms arising from the P 2 segment of the posterior cerebral artery (PCA are rare, accounting for less than 1% of all intracranial aneurysms. To date, few studies concerning the management of P 2 segment aneurysms have been reported. Objective: To review the microsurgical techniques and clinical outcomes of microsurgical treatment by different approaches in patients with aneurysms on the P 2 segment of the PCA. Materials and Methods: Forty-two patients with P2 segment aneurysms had microsurgical treatment by subtemporal approach. All the patients had drainage of cerebrospinal fluid for decompression, and indocyanine green (ICG angiography was used in 20 patients to assess the effect of clipping. Results: Of the 42 patients, 16 were operated by combined pterional-subtemporal approach. In 40 patients aneurysms were successfully treated by clipping the P 2 aneurysmal neck while preserving the parent artery. Two patients with giant aneurysms were treated using surgical trapping. Postoperatively, 41 patients had a good recovery. One patient after aneurysm trapping had ischemic infarction in the PCA tertiary and presented with hemiparesis and homonymous hemianopia. However, this patient recovered after three weeks of treatment. Conclusion: Subtemporal approach is the most appropriate approach to clip the aneurysms of the P 2 segment. It allows the neurosurgeon to operate on the aneurysms while preserving the patency of the parent artery. Gaint P 2 segment aneurysms can safely be treated by rapping of the aneurysm by combined subtemporal or pterional-subtemporal approach in experienced hands.ICG angiography will be an important tool in monitoring for the presence of residual aneurysm or perforating artery occlusion during aneurysm clipping. Preoperative lumbar drainage of cerebrospinal fluid may help to avoid temporal lobe damage.

  10. Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm.

    Science.gov (United States)

    Bowers, Christian A; Taussky, Philip; Park, Min S; Neil, Jayson A; Couldwell, William T

    2015-12-01

    We report the microsurgical rescue and removal of a Pipeline stent embolization of a giant internal carotid artery terminus aneurysm. After the initial placement of a Pipeline Embolization Device (PED), it migrated proximally to the cavernous carotid with the distal end free in the middle of the aneurysm, resulting in only partial aneurysm neck coverage. The patient underwent microsurgical rescue with trapping, bypass, and opening of the aneurysm with PED removal. The vessel remained patent in the proximal segment previously covered by the Pipeline stent. Microsurgical rescue for definitive aneurysm treatment with PED removal can be safe and effective for aneurysms unsuccessfully treated with PED.

  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. Basilar artery thrombosis in the setting of antiphospholipid syndrome.

    Science.gov (United States)

    Saad, Amin F; Nickell, Larry T; Heithaus, R Evans; Shamim, Sadat A; Opatowsky, Michael J; Layton, Kennith F

    2014-07-01

    Antiphospholipid syndrome is an autoimmune disorder characterized by arterial or venous thrombosis, recurrent first-trimester pregnancy loss, and multiple additional clinical manifestations. We describe a man with severe atherosclerotic basilar artery stenosis and superimposed in situ thrombus who was found to have antiphospholipid syndrome.

  13. Relaxation effect of abacavir on rat basilar arteries.

    Directory of Open Access Journals (Sweden)

    Rachel Wai Sum Li

    Full Text Available The use of abacavir has been linked with increased cardiovascular risk in patients with human immunodeficiency virus infection; however, the mechanism involved remains unclear. We hypothesize that abacavir may impair endothelial function. In addition, based on the structural similarity between abacavir and adenosine, we propose that abacavir may affect vascular contractility through endogenous adenosine release or adenosine receptors in blood vessels.The relaxation effect of abacavir on rat basilar arteries was studied using the myograph technique. Cyclic GMP and AMP levels were measured by immunoassay. The effects of abacavir on nucleoside transporters were studied using radiolabeled nucleoside uptake experiments. Ecto-5' nucleotidase activity was determined by measuring the generation of inorganic phosphate using adenosine monophosphate as the substrate.Abacavir induced the relaxation of rat basilar arteries in a concentration-dependent manner. This relaxation was abolished when endothelium was removed. In addition, the relaxation was diminished by the nitric oxide synthase inhibitor, L-NAME, the guanylyl cyclase inhibitor, ODQ, and the protein kinase G inhibitor, KT5820. Abacavir also increased the cGMP level in rat basilar arteries. Abacavir-induced relaxation was also abolished by adenosine A2 receptor blockers. However, abacavir had no effect on ecto-5' nucleotidase and nucleoside transporters. Short-term and long-term treatment of abacavir did not affect acetylcholine-induced relaxation in rat basilar arteries.Abacavir induces acute endothelium-dependent relaxation of rat basilar arteries, probably through the activation of adenosine A2 receptors in endothelial cells, which subsequently leads to the release of nitric oxide, resulting in activation of the cyclic guanosine monophosphate/protein kinase G-dependent pathway in vascular smooth muscle cells. It is speculated that abacavir-induced cardiovascular risk may not be related to

  14. Cephalic vein aneurysm.

    Science.gov (United States)

    Faraj, Walid; Selmo, Francesca; Hindi, Mia; Haddad, Fadi; Khalil, Ismail

    2007-11-01

    Cephalic vein aneurysms are rare malformations that may develop in any part of the vascular system, and their history, presentation, and management vary depending on their site. The etiology of venous aneurysms remains unclear, although several theories have been elaborated. Venous aneurysms are unusual vascular malformations that occur equally between the sexes and are seen at any age; they can present as either a painful or a painless subcutaneous mass. No serious complications have been reported from upper extremity venous aneurysms. Surgical excision is the definitive management for most of these. The case reported here presented with a painless and mobile, soft, subcutaneous mass that caused only cosmetic concern.

  15. Emergency endovascular repair of ruptured visceral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Tang Tjun

    2007-07-01

    Full Text Available Abstract Background Visceral artery aneurysms although rare, have very high mortality if they rupture. Case presentation An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented with hypovolemic shock while being treated in the hospital after undergoing total knee replacement. Endovascular embolization was successfully employed to treat this patient, with early hospital discharge. Conclusion Prompt diagnosis and endovascular management of ruptured visceral aneuryms can decrease the associated mortality and morbidity.

  16. Vertebro-Basilar Junction Aneurysms: A Single Centre Experience and Meta-Analysis of Endovascular Treatments

    OpenAIRE

    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-01-01

    Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin ...

  17. Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.

    Science.gov (United States)

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2015-07-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision.

  18. Management of Extracranial Carotid Artery Aneurysm

    NARCIS (Netherlands)

    Welleweerd, J. C.; den Ruijter, H. M.; Nelissen, B. G. L.; Bots, M. L.; Kappelle, L. J.; Rinkel, G. J. E.; Moll, F. L.; de Borst, G. J.

    2015-01-01

    Introduction: Aneurysms of the extracranial carotid artery (ECAA) are rare. Several treatments have been developed over the last 20 years, yet the preferred method to treat ECAA remains unknown. This paper is a review of all available literature on the risk of complications and long-term outcome aft

  19. Treating Arrhythmias in Children

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Treating Arrhythmias in Children Updated:Dec 21,2016 Many options ... card This content was last reviewed September 2016. Arrhythmia • Home • About Arrhythmia • Why Arrhythmia Matters • Understand Your ...

  20. Considerações clínicas e cirúrgicas sobre aneurismas intracranianos Clinical and surgical considerations on intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Mário S. Cademartori

    1969-09-01

    Full Text Available São revistos os principais sintomas apresentados por 83 pacientes com aneurismas intracranianos nas seguintes localizações: 41 no sistema carotídeo, 19 no da artéria silviana, 19 no da artéria cerebral anterior e 4 no da artéria basilar. Como método de tratamento, a cirurgia intracraniana foi realizada em 49 pacientes, dos quais 27 apresentavam aneurisma no sifão carotídeo, 14 na cerebral média e 8 na cerebral anterior. A mortalidade operatoria foi de 37% entre os pacientes com aneurisma do sifão carotídeo, de 28,5% nos do grupo da artéria silviana e de 50% nos do grupo da artéria cerebral anterior. Não houve óbito nos 7 pacientes nos quais foi feita oclusão da carótida. A morbilidade foi de 12% nos casos de aneurismas carotídeos, de 20% nos de aneurismas da cerebral média, de 50% nos de cerebral anterior e de 29% naqueles em que a carótida primitiva foi ligada. Como métodos auxiliares, foi utilizada a hipotermia com circulação extra-corpórea em dois pacientes com aneurismas da artéria comunicante anterior e drenagem espinhal contínua em 19 casos. Controles arteriográficos pós-operatórios, feitos em 16 casos, permitiram verificar a eficácia dos procedimentos utilizados bem como algumas falhas de técnica cirúrgica.The clinical manifestations presented by 83 patients with intracranial aneurysms are reviewed. The site of the aneurysms were: 41 in the internal carotid, 19 in the middle cerebral, 19 in the anterior cerebral and 4 in the basilar artery. Rebleeding occurred in 17 cases; 12 of these patients died, Intracranial surgery was undertaken in 27 cases of aneuysms of the carotid, 14 the middle cerebral and 8 of the anterior cerebral artery. Seven patients were treated by occlusion of the internal carotid in the neck. Surgical mortality was of 37% among the cases of aneurysms of the carotid, of 28,5% among the middle cerebral artery cases and of 50% in those with aneurysms in the anterior cerebral artery system

  1. Current management of inguinal false aneurysms

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Michael Jepsen, Jørn; Saicu, Christian;

    2016-01-01

    from puncture sites after percutaeous intervention. Anticoagulative medication, low patelet counts and severely calcified vessels increase the risk of forming a false aneurysm. Experienced specialists may make the diagnosis from physical examination, but ultrasound imaging is almost always needed...... 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...

  2. Ruptured aneurysm of the PICA communicating artery: a case report.

    Science.gov (United States)

    Haga, Daisuke; Kuroki, Takao; Andoh, Shunpei; Nemoto, Masaaki; Sugo, Nobuo; Nagao, Takeki

    2014-01-01

    A 47-year-old man presented with a rare aneurysm arising from the posterior inferior cerebellar artery communicating artery (PICA com A), manifesting as subarachnoid with intraventricular hemorrhage. Cerebral angiography showed a defect of the left PICA, and the left PICA region was supplied by a communicating artery formed by the fusion of branches from the right PICA and right vertebral artery. Aneurysms arose in the communicating artery, and a small, unruptured fusiform aneurysm was observed adjacent to a ruptured aneurysm. Trapping was performed for the 2 aneurysms with occipital artery (OA)-PICA bypass. Six cases of aneurysms occurring in this vessel including ours have been reported, and hemodynamic factors and congenital fragility of the arterial wall have been suggested as causative factors. Ours is the first case in which a ruptured aneurysm of this vessel was treated surgically with concurrent vascular reconstruction. If the aneurysm has a shape that is difficult to clip, the affected vessel is difficult to preserve, and collateral blood flow to the affected PICA region is considered insufficient, trapping with OA-PICA bypass is recommended.

  3. PATIENT-SPECIFIC BLOOD DYNAMIC SIMULATIONS IN ASSESSING ENDOVASCULAR OCCLUSION OF INTRACRANIAL ANEURYSMS

    Institute of Scientific and Technical Information of China (English)

    CHEN Jia-liang; WANG Sheng-zhang; DING Guang-hong; YANG Xin-jian; LI Hai-yun

    2009-01-01

    According to recent studies, there are various potential predictors for surgical outcome for cerebral aneurysms. An accurate surgical outcome assessment would help make better-informed decisions and avoid the risk of rebleeding. It is well known that hemodynamic factors play an important role in the pathogenesis and treatment of intracranial aneurysms. In this article, a computational fluid dynamic analysis is applied to one patient-specific model of the cerebral aneurysm located at the tip of basilar artery, by which the differences of hemodynamic parameters before and after endovascular treatment may be evaluated. Based on the model, we show that the flow behavior near the neck of the aneurysm sees great differences after endovascular treatment as compared with that before treatment, which also affects the wall shear stress and the displacement distribution. In addition, our whole simulation process is based on a series of CFD commercial software packages, which are easily available for doctors to implement such a method in their daily practice. These results would be used to assess the outcome of endovascular treatment for the aneurysm occlusion.

  4. Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms

    DEFF Research Database (Denmark)

    Ertl, L; Holtmannspötter, M; Patzig, M

    2014-01-01

    BACKGROUND AND PURPOSE: Fusiform vertebrobasilar giant aneurysms are a rare (intracranial aneurysms) but challenging aneurysm subtype. Little data are available on the natural history of this aneurysm subtype and the impact of the use of flow-diverting stents on the long-term clinical...... and imaging follow-up. In this article, we present our experience with the treatment of fusiform vertebrobasilar giant aneurysms by flow diverting stents. We aim to stimulate a discussion of the best management paradigm for this challenging aneurysm subtype. MATERIALS AND METHODS: We retrospectively...... identified 6 patients with fusiform vertebrobasilar giant aneurysms who had been treated with flow-diverting stents between October 2009 and March 2012 in our center. The available data were re-evaluated. The modified Rankin Scale score was assessed before intervention, during the stay in hospital...

  5. [Incidentally detected bronchial artery aneurysm with combined operation for mitral regurgitation;report of a case].

    Science.gov (United States)

    Sato, Hisashi; Oteki, Hitoshi; Naito, Kozo; Yunoki, Junji

    2015-02-01

    A 77-year-old woman was admitted to the hospital for heart failure with orthopnea. Echocardiography revealed massive mitral regurgitation. During preoperative cardiac catheterization, an aneurysm was indentified incidentally just below the tracheal carina. Three dimensional computed tomography showed three bronchial artery aneurysms behind the pulmonary artery and the left atrium. The proximal aneurysm was the largest and was 22 mm in diameter. It was resected by retracting the ascending aorta to the left, the superior vana cava to the right and right pulmonary artery cranially under cardiopulmonary bypass, and mitral valve plasty was performed. We believed that resection of the proximal aneurysm would cause thrombotic occlusion of the other 2 aneurysms. Bronchial artery aneurysm is a rare entity that is observed in fewer than 1% of those who undergo selective bronchial arteriography. In addition, because bronchial artery aneurysm is a potentially life-threatening lesion, it should be treated promptly when diagnosed.

  6. [Basilar ectasia and stroke: clinical aspects of 21 cases].

    Science.gov (United States)

    de Oliveira, R de M; Cardeal, J O; Lima, J G

    1997-09-01

    Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

  7. Hemodynamic Impact of a Spontaneous Cervical Dissection on an Ipsilateral Saccular Aneurysm

    Science.gov (United States)

    See, Alfred P.; Penn, David L.; Du, Rose; Frerichs, Kai U

    2016-01-01

    The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.

  8. 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.)

  9. A systematic review of pipeline embolization device for giant intracranial aneurysms.

    Science.gov (United States)

    Lv, Xianli; Ge, Huijian; He, Hongwei; Jiang, Chuhan; Li, Youxiang

    2017-01-01

    The experience with respect to the treatment of giant intracranial aneurysms with flow-diversion devices is limited. The aim of the present systematic review was to evaluate the effect of the pipeline embolization device (PED) on giant intracranial aneurysms. Eligible related articles were identified by searching the PubMed, Web of Science, Springer, ScienceDirect, and OVID databases using "giant aneurysm" and "pipeline" as the search items. The date of the last search was November 20, 2015. This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In a total of 9 eligible studies with 200 patients and 215 aneurysms, 40 (18.6%) giant (aneurysm diameter >25mm) intracranial aneurysms treated with PED were analyzed. During a 6 to 34 month follow-up, complete occlusion was achieved in 23 (57.5%) cases. Seven patients (17.5%) developed intracranial hemorrhage, 5 developed ischemic attack (12.5%), and 13 (32.5%) developed a mass effect after PED treatment. The complication rate was 77.8% in PED for giant vertebrobasilar artery aneurysms. The cumulative mortality rate for giant paraclinoid carotid artery and middle cerebral artery aneurysms was 13.3% and increased up to 50% for giant vertebrobasilar artery aneurysms. The complete obliteration rate of PED for giant intracranial aneurysms was approximately 60%. Mass effect is the most mechanism of complications. Complication and mortality rates associated with PED for giant vertebrobasilar artery aneurysms are still extremely high.

  10. Incidence of basilar invagination in patients with tonsillar herniation ? a case control craniometrical study

    Directory of Open Access Journals (Sweden)

    Andrei F Joaquim

    2014-09-01

    Full Text Available A retrospective case-control study based on craniometrical evaluation was performed to evaluate the incidence of basilar invagination (BI. Patients with symptomatic tonsillar herniation treated surgically had craniometrical parameters evaluated based on CT scan reconstructions before surgery. BI was diagnosed when the tip of the odontoid trespassed the Chamberlain’s line in three different thresholds found in the literature: 2, 5 or 6.6 mm. In the surgical group (SU, the mean distance of the tip of the odontoid process above the Chamberlain’s line was 12 mm versus 1.2 mm in the control (CO group (p<0.0001. The number of patients with BI according to the threshold used (2, 5 or 6.6 mm in the SU group was respectively 19 (95%, 16 (80% and 15 (75% and in the CO group it was 15 (37%, 4 (10% and 2 (5%.

  11. Pediatric cerebral aneurysms.

    Science.gov (United States)

    Gemmete, Joseph J; Toma, Ahmed K; Davagnanam, Indran; Robertson, Fergus; Brew, Stefan

    2013-11-01

    Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented.

  12. Concomitant percutaneous treatment of aortic coarctation and associated intercostal aneurysms: pre-procedural recognition is key.

    Science.gov (United States)

    Batlivala, Sarosh P; Rome, Jonathan J

    2016-02-01

    Intercostal aneurysms are associated with aortic coarctation. Their aetiology is not well-understood but may be related to intrinsic vascular pathology and altered flow dynamics through the intercostal artery. We present the cases of two patients with coarctation and intercostal aneurysms. The aneurysms were recognised on pre-catheterisation imaging studies and were selectively occluded during the same procedure to treat the coarctation. There were no complications; both the patients have no residual coarctation at the most recent follow-up. Intercostal aneurysms associated with coarctation can have significant consequences including late rupture, paralysis, and even death. These aneurysms are common with an incidence of up to 40% with adult-diagnosed coarctation; one treatment plan is to treat both the coarctation and aneurysm during a single catheterisation. Pre-catheterisation CT or MRI may play a role in this strategy.

  13. 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...

  14. Endovascular treatment of coarctation and related aneurysms.

    Science.gov (United States)

    Galiñanes, E L; Krajcer, Z

    2014-06-11

    Today,surgical repair has almost doubled the 30year survival rate in patients with coarctation of the aorta (CoA), and 72% to 98% of patients now reach adulthood. Possible late complications include malignant hypertension, left ventricular dysfunction, aortic valve dysfunction, recurrent CoA, and aneurysm formation with risk of rupture. Treating postoperative CoA-related aneurysms with observation alone is associated with a mortality rate of 36%, compared with 9% for surgical repair. Even in the best surgeons' hands, aortic surgery has associated complications, and the complexity of reoperative surgery makes the risks substantially greater. For patients with CoA-related aneurysm, endovascular treatment constitutes a good alternative to reoperative surgery because it poses a lower risk of morbidity and mortality. Implanting an endograft has been shown to be successful in treating CoA and related aneurysms, producing excellent intermediate outcomes and minimal morbidity and mortality. Despite evidence that using covered stents improves outcomes, the superiority of any particular stent type has yet to be established. With a variety of endografts available, the decision of which stent to use depends on anatomy, availability, and operator preference.

  15. The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: A systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    N. Armstrong (Nigel); L.T. Burgers (Laura); S. Deshpande (Sohan); M.J. Al (Maiwenn); R. Riemsma; S.R. Vallabhaneni; P. Holt (Peter); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground: Patients with large abdominal aortic aneurysms (AAAs) are usually offered reparative treatment given the high mortality risk. There is uncertainty about how to treat juxtarenal AAAs (JRAAAs) or thoracoabdominal aortic aneurysms (TAAAs). Endovascular repair of an abdominal aor

  16. Treatment of Intracranial Aneurysms: Clipping Versus Coiling.

    Science.gov (United States)

    Liu, Ann; Huang, Judy

    2015-09-01

    Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics. The spectrum of presentation of IAs ranges from incidental detection to devastating subarachnoid hemorrhage. Although the gold standard imaging technique is intra-arterial digital subtraction angiography, other modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are being increasingly used for screening and treatment planning. Management of these patients depends upon a number of factors including aneurysmal, patient, institutional, and operator factors. The ultimate goal of treating patients with IAs is complete and permanent occlusion of the aneurysm sac in order to eliminate future hemorrhagic risk, while preserving or restoring the patient's neurological function. The most common treatment approaches include microsurgical clipping and endovascular coiling, and multiple studies have compared these two techniques. To date, three large prospective, randomized studies have been done: a study from Finland, International Subarachnoid Aneurysm Trial (ISAT), and the Barrow Ruptured Aneurysm Trial (BRAT). Despite differences in methodology, the results were similar: in patients undergoing coiling, although rates of rebleeding and retreatment are higher, the overall rate of poor outcomes at 12 months was significantly lower. As minimally invasive procedures and devices continue to be refined, endovascular strategies are likely to increase in popularity. However, as long-term outcome studies become available, it is increasingly apparent that they are complementary treatment strategies, with patient selection of critical importance.

  17. Endovascular treatment of a small infrarenal abdominal aortic aneurysm causing duodenal obstruction: Case report and literature review.

    Science.gov (United States)

    Esposito, Andrea; Menna, Danilo; Mansour, Wassim; Sirignano, Pasqualino; Capoccia, Laura; Speziale, Francesco

    2015-06-01

    Duodenal obstruction caused by abdominal aortic aneurysm was first described by Osler in 1905 and is named "aortoduodenal syndrome." This condition has always been treated by open surgical repair. We report the first case of aortoduodenal syndrome successfully treated by endovascular aneurysm repair. A 74-year-old male patient referred to our hospital complaining postprandial vomit, reporting a consistent weight loss in the latest weeks. Enhanced computed tomography scans showed a small saccular abdominal aortic aneurysm compressing duodenum and inferior vena cava without any other evident pathological finding. As the patient underwent a successful endovascular treatment of the abdominal aortic aneurysm, symptoms immediately resolved so that he started back to feed and progressively gained body weight. Despite aortoduodenal syndrome is generally caused by large abdominal aortic aneurysm, this condition has to be suspected also in case of small abdominal aortic aneurysm. Differently from what has been reported in literature, endovascular aneurysm repair could be effective in the treatment of aortoduodenal syndrome.

  18. Cerebral Aneurysms Fact Sheet

    Science.gov (United States)

    ... the flow of blood to the aneurysm. Under anesthesia, a section of the skull is removed and ... Page NINDS Inclusion Body Myositis Information Page Traumatic Brain Injury Information Page NINDS Incontinentia Pigmenti Information Page Trigeminal ...

  19. Intracranial Arterial Aneurysms

    OpenAIRE

    J Gordon Millichap

    1988-01-01

    Neurosurgeons from the Universita degli Studi di Roma “La Saspeinza,” Rome, Italy, report a 4-year-old girl with a cerebral saccular aneurysm and analyze 71 cases under 5 years of age in the literature.

  20. Surgical options for the management of visceral artery aneurysms.

    Science.gov (United States)

    Van Petersen, A; Meerwaldt, R; Geelkerken, R; Zeebregts, C

    2011-06-01

    Visceral artery aneurysm (VAA) is a rare entity but increased use of abdominal imaging has led to an increased prevalence. Rupture is related to a high mortality rate. Open repair, endovascular treatment and laparoscopic techniques have been described as treatment options. In this systematic review we describe the surgical options for treating VAA. A literature search identified articles focussing on the key issues of visceral artery aneurysms and surgical options using the Pubmed and Cochrane databases. Case reports dominate the literature about VAA. Twenty-seven small case series and ten review articles have been published in the last 20 years concerning the surgical options for VAA. The evidence does not exceed level 3. Surgical treatment is dictated by both patient and aneurysm characteristics. Whether VAA should be treated largely depends upon age, gender, presence of hypertension (e.g. in renal aneurysm), aneurysm size and presentation. Aneurysm size and characteristics, anatomical location and presence of collateral circulation dictate the surgical option to be chosen. The mortality and morbidity rates after elective open repair are low. Literature about surgical options for treating VAA remains scarce. Only a few clinical trials have shown the possibilities and results of open surgical repair. In general, there is no consensus on the surgical treatment of VAA and the highest level of evidence is based upon expert opinions.

  1. Image based numerical simulation of hemodynamics in a intracranial aneurysm

    Science.gov (United States)

    Le, Trung; Ge, Liang; Sotiropoulos, Fotis; Kallmes, David; Cloft, Harry; Lewis, Debra; Dai, Daying; Ding, Yonghong; Kadirvel, Ramanathan

    2007-11-01

    Image-based numerical simulations of hemodynamics in a intracranial aneurysm are carried out. The numerical solver based on CURVIB (curvilinear grid/immersed boundary method) approach developed in Ge and Sotiropoulos, JCP 2007 is used to simulate the blood flow. A curvilinear grid system that gradually follows the curved geometry of artery wall and consists of approximately 5M grid nodes is constructed as the background grid system and the boundaries of the investigated artery and aneurysm are treated as immersed boundaries. The surface geometry of aneurysm wall is reconstructed from an angiography study of an aneurysm formed on the common carotid artery (CCA) of a rabbit and discretized with triangular meshes. At the inlet a physiological flow waveform is specified and direct numerical simulations are used to simulate the blood flow. Very rich vortical dynamics is observed within the aneurysm area, with a ring like vortex sheds from the proximal side of aneurysm, develops and impinge onto the distal side of the aneurysm as flow develops, and destructs into smaller vortices during later cardiac cycle. This work was supported in part by the University of Minnesota Supercomputing Institute.

  2. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (> 3 mm).Between November 1999 and November 2009...... 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...... and subsequently comparing it to the results of larger aneurysms.Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54...

  3. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome

    NARCIS (Netherlands)

    Compter, A.; Hoeven, E.J. van der; Worp, H.B. van der; Vos, J.A.; Weimar, C.; Rueckert, C.M.; Kappelle, L.J.; Algra, A.; Schonewille, W.J.; Leeuw, F.E. de

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  4. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS) : prevalence and outcome

    NARCIS (Netherlands)

    Compter, Annette; van der Hoeven, Erik J R J; van der Worp, H. Bart; Vos, Jan Albert; Weimar, Christian; Rueckert, Christina M.; Kappelle, L. Jaap; Algra, Ale; Schonewille, Wouter J.; Vergouwen, MD

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  5. Screening for Abdominal Aortic Aneurysm

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  6. Abdominal aortic aneurysm repair - open

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007392.htm Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  7. Basilar artery occlusion: Prognostic signs of severity on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre, E-mail: pierre-alexandre.poletti@hcuge.ch [Service of Radiology, University Hospital of Geneva (Switzerland); Pereira, Vitor Mendes [Service of Neuroradiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Department of Medical Imaging, University of Toronto (Canada); Department of Surgery, University of Toronto (Canada); Lovblad, Karl-Olof [Service of Neuroradiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Canel, Lucie [Service of Radiology, University Hospital of Geneva (Switzerland); Sztajzel, Roman [Service of Neurology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Becker, Minerva [Service of Radiology, University Hospital of Geneva (Switzerland); Perneger, Thomas [Division of Clinical Epidemiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Platon, Alexandra [Service of Radiology, University Hospital of Geneva (Switzerland)

    2015-07-15

    Highlights: • The main CT signs associated with basilar artery occlusion were analyzed. • CT sign of acute ischemic lesion is significantly associated with a bad outcome. • The site of the basilar artery occlusion is not associated to the patients’ outcome. - Abstract: Purpose: To determine the computed tomography (CT) signs that are predictive of the clinical outcome of basilar artery occlusion (BAO). Materials and methods: The study population consisted in 37 patients (14 women, 23 men, mean age: 63 years), admitted with onset of neurological deficit, starting 1–72 h prior to admission, who were diagnosed with BAO on the basis of a CT examination with intravenous contrast agent. The following signs were collected on CT scans performed on admission: clot density on noncontrast images, clot length, and clot location, as well as the presence of acute ischemic lesions. The results were compared against the modified Rankin Scale (mRS) score of patients at 3 months, favorable clinical outcome being defined as a mRS score ≤3. Results: The clinical outcome was favorable in 13 (35%) of the 37 patients and unfavorable in 24 (65%). Signs of acute ischemia were visible in 13 of the 24 patients with unfavorable outcome but in none of the 13 patients with favorable outcome (p < 0.001). None of the other CT signs analyzed were significantly correlated with clinical prognosis. Conclusion: Of all the CT signs analyzed, only the presence of signs of acute ischemia on the admission CT of patients with BAO was associated with poor prognosis.

  8. Surgical treatment of Chiari malformation complicated with basilar impression

    Directory of Open Access Journals (Sweden)

    Yuan MA

    2011-02-01

    Full Text Available Objective To evaluate the therapeutic effect of small craniotomic posterior fossa decompression combined with occipital-cervical bone graft fusion and internal fixation on Chiari malformation complicated with basilar impression.Methods The clinical data of 16 cases(7 males and 9 females,aged 17 to 65 years,mean 36.4 of Chiari malformation complicated with basilar impression from 2006 to 2010 were retrospectively analyzed.The diagnoses for all the patients were confirmed by radiology.Small craniotomic posterior fossa decompression was performed in all patients,cerebellar tonsils were resected,and then one-stage occipital-cervical bone graft fusion using autogenous iliac bone and internal wiring fixation were performed.Neck support was used for 3 months after surgery.Results Symptoms were significantly improved in all cases after surgical operation.No patient died or infected.Cerebrospinal fluid leakage was found at draining site in one case.Transient pain of scapular and chest was found in one case and disappeared spontaneously.A 6-months follow-up showed that 6 patients were cured,9 improved and 1 unchanged according to Symon and Lavender standard.Postoperative MRI showed the reconstructed cisterna magna was clear in all patients,no cerebellar ptosis was found,and the occipital-cervical graft bone was fused.Conclusion In patients with Chiari malformation complicated with basilar impression,small craniotomic posterior fossa decompression combined with one-stage occipital-cervical bone graft fusion and internal wiring fixation has a clear and definite effect,it can increase the volume of posterior fossa and alleviate the ventral brain stem compression simultaneously,and reconstruct the stability of cranio-cervical junction.

  9. Endovascular treatment of ruptured proximal pica aneurysms: A single-center 5-years experience

    Directory of Open Access Journals (Sweden)

    Vivek Gupta

    2014-01-01

    Full Text Available Background and Purpose: Posterior inferior cerebellar artery (PICA like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA - PICA junction and the proximal segment of the PICA. The use of endovascular treatment as an alternative treatment to surgery has been increasing. We present our last 5 years experience in treating the ruptured proximal PICA aneurysms. Materials and Methods: Retrospective analysis of records of all patients with ruptured VA-PICA junction aneurysms treated at our referral center between July 2008 and July 2013 was performed. Over the last 5 years, we came across 17 patients who had aneurysms of proximal PICA or VA-PICA junction out of which 13 patients underwent endovascular treatment for ruptured saccular VA-PICA junction aneurysms and were the focus of this research. Follow-up studies ranged from 6 months to 3 years. Results: All the patients presented with an acute intracranial hemorrhage on NCCT. All the aneurysms were at VA-PICA junction with partial or complete incorporation of PICA origin in the sac. Endovascular treatment of all the 13 aneurysm was successful in the first attempt. Aneurysms were treated with balloon assisted coiling either by placing the balloon across the VA-PICA junction (n = 3 or in the vertebral artery proper (n = 9. Stent assisted coiling VA-PICA was performed in one aneurysm (n = 1. There was no intra-procedural rupture of the aneurysms. Conclusion: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first line treatment.

  10. Stent-based mechanical thrombectomy in acute basilar artery occlusion.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Moscovici, Samuel; Attia, Moshe; Itshayek, Eyal

    2011-12-01

    Stent-based mechanical thrombectomy was recently proposed as an effective alternative to other mechanical techniques to achieve recanalization of large-vessel embolic occlusions in the anterior circulation. To our knowledge, there are no reports of the use of this technique in acute basilar artery occlusion (ABAO). We present a patient with complete endovascular recanalization of ABAO using a stent-based thrombectomy technique. Advantages and limitations of this technique in the management of ABAO are discussed. The stent-thrombectomy technique is promising, and will need further evaluation in posterior circulation stroke.

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

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Rhim, Jong Kook; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jeong Jin [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeon, Jin Pyeong [Dept. of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2015-10-15

    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.

  12. Interleukin-6 as a Prognostic Biomarker in Ruptured Intracranial Aneurysms.

    Directory of Open Access Journals (Sweden)

    Hung-Wen Kao

    Full Text Available Interleukin-6 (IL-6, a proinflammatory cytokine, was found to surge in the cerebral spinal fluid after aneurysmal subarachnoid hemorrhage (SAH. We hypothesized that the plasma level of IL-6 could be an independent biomarker in predicting clinical outcome of patients with ruptured intracranial aneurysm.We prospectively included 53 consecutive patients treated with platinum coil embolization of the ruptured intracranial aneurysm. Plasma IL-6 levels were measured in the blood samples at the orifices of the aneurysms and from peripheral veins. The outcome measure was the modified Rankin Scale one month after SAH. Multiple logistic regression analyses were used to evaluate the associations between the plasma IL-6 levels and the neurological outcome.Significant risk factors for the poor outcome were old age, low Glasgow Coma Scale (GCS on day 0, high Fisher grades, and high aneurysmal and venous IL-6 levels in univariate analyses. Aneurysmal IL-6 levels showed modest to moderate correlations with GCS on day 0, vasospasm grade and Fisher grade. A strong correlation was found between the aneurysmal and the corresponding venous IL-6 levels (ρ = 0.721; P<0.001. In the multiple logistic regression models, the poor 30-day mRS was significantly associated with high aneurysmal IL-6 level (OR, 17.97; 95% CI, 1.51-214.33; P = 0.022 and marginally associated with high venous IL-6 level (OR, 12.71; 95% CI, 0.90-180.35; P = 0.022 after adjusting for dichotomized age, GCS on day 0, and vasospasm and Fisher grades.The plasma level of IL-6 is an independent prognostic biomarker that could be used to aid in the identification of patients at high-risk of poor neurological outcome after rupture of the intracranial aneurysm.

  13. Risk of Familial Intracranial Aneurysm

    OpenAIRE

    J Gordon Millichap; Millichap, John J.

    2014-01-01

    Investigators at University Medical Center Utrecht, Netherlands, studied the yield of long-term (up to 20 years) screening for intracranial aneurysms in individuals with a positive family history (2 or more first-degree relatives) of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysm (1993-2013).

  14. Mouse models of intracranial aneurysm.

    Science.gov (United States)

    Wang, Yutang; Emeto, Theophilus I; Lee, James; Marshman, Laurence; Moran, Corey; Seto, Sai-wang; Golledge, Jonathan

    2015-05-01

    Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm is a highly lethal medical condition. Current management strategies for unruptured intracranial aneurysms involve radiological surveillance and neurosurgical or endovascular interventions. There is no pharmacological treatment available to decrease the risk of aneurysm rupture and subsequent subarachnoid hemorrhage. There is growing interest in the pathogenesis of intracranial aneurysm focused on the development of drug therapies to decrease the incidence of aneurysm rupture. The study of rodent models of intracranial aneurysms has the potential to improve our understanding of intracranial aneurysm development and progression. This review summarizes current mouse models of intact and ruptured intracranial aneurysms and discusses the relevance of these models to human intracranial aneurysms. The article also reviews the importance of these models in investigating the molecular mechanisms involved in the disease. Finally, potential pharmaceutical targets for intracranial aneurysm suggested by previous studies are discussed. Examples of potential drug targets include matrix metalloproteinases, stromal cell-derived factor-1, tumor necrosis factor-α, the renin-angiotensin system and the β-estrogen receptor. An agreed clear, precise and reproducible definition of what constitutes an aneurysm in the models would assist in their use to better understand the pathology of intracranial aneurysm and applying findings to patients.

  15. Pathological observation of brain arteries and spontaneous aneurysms in hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To investigate the role of hypertension in the pathogenesis of cerebral aneurysms in rats.Methods Twenty spontaneous hypertensive rats (SHR) and 10 Wistar-Kyoto rats (WKY) were included in this observational study. Animals were fed with normal diet and drinking water. No experimental modifications were undertaken in either group. They were sacrificed at one year of age, the bifurcations of the circle of Willis were dissected and longitudinal serial sections were prepared for light microscopic and transmission electron microscopic study.Results In the SHR group, 2 of the 20 rats formed an aneurysm respectively at the bifurcations of the basilar artery. As revealed by electron microscopy, injury at the bifurcation of the artery first occurred on the steeper side of the intimal pad. Furthermore, loss of endothelial cells, small depressions on the intima, disruptive internal elastic lamina and lymphocytes or red blood cells infiltration were noted at the steeper side of the intimal pad. No significant changes were observed in WKY group.Conclusions Cerebral aneurysms can form spontaneously in SHR without ligation of the common carotid artery and without a diet containing β-aminoproprionitrile. Long-standing systemic arterial hypertension is one of the etiological factors that contributes to aneurysm formation in SHR rats.

  16. Mycotic pulmonary artery aneurysm as an unusual complication of thoracic actinomycosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung-Soo; Lee, Sang-Yeub [Wonkwang University College, Iksan (Korea, Republic of); Oh, Yu-Whan; Noh, Hyung-Jun; Lee, Ki-Yeol; Kang, Eun-Young [Korea University Hospital and Korea University College, Seoul (Korea, Republic of)

    2004-03-15

    Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis and generalized vasculitis. To our knowledge, mycotic aneurysms caused by pulmonary actinomycosis have not been reported in the radiologic literature. Herein, a case of pulmonary actinomycosis complicated by mycotic aneurysm is presented. On CT scans, this case showed focal aneurysmal dilatation of a peripheral pulmonary artery within necrotizing pneumonia of the right lower lobe, which was successfully treated with transcatheter embolization using wire coils.

  17. Endovascular repair for abdominal aortic aneurysm followed by type B dissection.

    Science.gov (United States)

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu

    2016-10-01

    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  18. Pulsatile blood flow in Abdominal Aortic Aneurysms

    Science.gov (United States)

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  19. Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

    Directory of Open Access Journals (Sweden)

    Ferrón JA

    2010-06-01

    Full Text Available Abstract Background Visceral artery aneurysms (VAA, although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

  20. Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review.

    Science.gov (United States)

    Anichini, G; Passacantilli, E; Lenzi, J; Guidetti, G; Santoro, A

    2012-04-01

    Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery.

  1. Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant.

    Science.gov (United States)

    Savastano, Luis E; Chaudhary, Neeraj; Gemmete, Joseph J; Garton, Hugh J L; Maher, Cormac O; Pandey, Aditya S

    2014-11-01

    Pediatric intracranial aneurysms are rare and challenging to treat. Achieving efficacy and durability of aneurysmal occlusion while maintaining parent vessel patency requires innovative treatment strategies, especially in cases in which aneurysmal location or morphology pose substantial morbidity associated with microsurgical treatment. In the last 3 decades, endovascular treatments have had a remarkable evolution and are currently considered safe and effective therapeutic options for cerebral aneurysms. While endovascular techniques are well described in the English literature, the endovascular management of pediatric aneurysms continues to pose a challenge. In this report, the authors describe the case of a 9-month-old infant who presented with a 1-day history of acute-onset left-sided hemiparesis and left facial droop. Imaging revealed a large symptomatic saccular middle cerebral artery aneurysm. Treatment included successful stent-assisted aneurysm coiling. At follow-up, the patient continued to fare well and MR angiography confirmed complete occlusion of the aneurysm dome. This case features the youngest patient in the English literature to harbor an intracranial aneurysm successfully treated with stent-assisted coiling. Based on this experience, endovascular intervention with vascular reconstruction can be safe and effective for the treatment of infants and could further improve prognosis; however, further studies are necessary to confirm these findings.

  2. Endovascular repair of multiple infrageniculate aneurysms in a patient with vascular type Ehlers-Danlos syndrome.

    Science.gov (United States)

    Domenick, Natalie; Cho, Jae S; Abu Hamad, Ghassan; Makaroun, Michel S; Chaer, Rabih A

    2011-09-01

    Patients with vascular type Ehler-Danlos syndrome can develop aneurysms in unusual locations. We describe the case of a 33-year-old woman with vascular type Ehlers-Danlos syndrome who developed metachronous tibial artery aneurysms that were sequentially treated with endovascular means.

  3. Pulmonary Artery Aneurysm as a Cause of Massive Hemoptysis: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Peter Corr

    2011-01-01

    Full Text Available Massive hemoptysis is a life-threatening medical emergency. Prompt radiological diagnosis and management are essential. I present a case of an inflammatory pulmonary aneurysm (Rasmussen aneurysm from active pulmonary tuberculosis. This is an uncommon cause for massive hemoptysis which was successfully treated by endovascular coiling.

  4. Acute subdural hematoma secondary to distal middle cerebral artery aneurysm rupture in a newborn infant.

    Science.gov (United States)

    Iza-Vallejo, Begoña; Mateo-Sierra, Olga; Fortea-Gil, Fernando; Ruiz-Juretschke, Fernando; Martín, Yolanda Ruiz

    2009-05-01

    The authors present the case of a peripheral aneurysmal lesion that developed in a newborn baby and was successfully treated by endovascular parent artery occlusion. Given the natural history of aneurysms, which are prone to rupture and to cause deleterious intracerebral hemorrhage, with high mortality rates, aggressive and early management (endovascular or surgical) is recommended.

  5. Treatment of popliteal artery aneurysms with the Hemobahn stent-graft

    NARCIS (Netherlands)

    Tielliu, IFJ; Verhoeven, ELG; Prins, TR; Post, WJ; Hulsebos, RG; van den Dungen, JJAM

    2003-01-01

    Purpose: To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft. Methods: In a recent 3-year period, 21 patients (18 men; median age 67 years, range 5282) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up

  6. Endovascular management of bilateral superior intercostal artery aneurysms following late repair of coarctation of the aorta.

    Science.gov (United States)

    Tapping, C R; Ettles, D F

    2011-08-01

    Endovascular management of massive bilateral superior intercostal artery aneurysms following late surgical repair of juxtaductal coarctation of the aorta is described in a 40-year-old male patient. Both aneurysms were successfully treated by coil embolisation without the need for further surgical intervention.

  7. Local lysis in acute basilar artery occlusions: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Karnik, R.; Perneczky, G.; Ammerer, H.P.; Brenner, H.; Slany, J. (Krankenanstalt der Stadt Wien Rudolfstiftung (Austria))

    1984-01-01

    Thrombosis of the basilar artery is not a rare disease, and the mortality is reported to be 60 to 80%. Present standard therapy with heparin infusions yields poor results. The high risk of intracerebral haemorrhage prohibits systemic fibrinolytic therapy. Due to these facts and good experience in our department with the use of local intracoronary lysis in acute myocardial infarction, the method of local thrombolysis was applied in a case of acute basiliar artery thrombosis. Fibrinolytic therapy was started via an angiography catheter placed in the vertebral artery in a 28 year-old woman with hemiplegia and severe brain stem symptoms. The patient received 200,000 IU streptokinase within 2 hours and subsequently 300,000 IU urokinase within 10 hours. The vessel re-opened completely. The neurological symptoms decreased during the following weeks. Based on this experience and according to rare reports in the literature we believe local low-dose thrombolysis to be a causal therapy promising success for acute thrombosis of the basilar artery. This therapy can be carried out in every medical centre able to perform selective angiography and experienced in the administration of fibrinolytic drugs.

  8. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  9. CT features of mycotic aneurysms; Caracteristicas por TC de los aneurismas micoticos

    Energy Technology Data Exchange (ETDEWEB)

    Masaguer, S.; Pages, M.; Sanchez, M.; Real, M.; Ayuso, J. R.; Caralt, R. M. de; Ayuso, C. [Hospital Clinic de Barcelona (Spain)

    2003-07-01

    To describe CT features of mycotic aneurysms. We have retrospectively checked 10 patients diagnosed with mycotic aneurysm. Three revealed previously treated arteriosclerotic aneurysms, one was diabetic and had undergone a reno pancreatic transplant, and another presented advanced HIV infection. They all presented fever syndrome and eight exhibited leucocytosis. Mycotic aneurysm diagnosis was made by means of CT findings, clinical examination and positive hemo culture in all cases. Anatomopathological findings were available as confirmation for all four surgically treated patients. The CT scan was performed during arterial phase with spiral acquisition, without contrast and with endo venous administration of a contrast medium. Saccular aneurysms were found in seven patients (double aneurysms in the case of two), with seven of these being abdominal aneurysms (one retrocrural aortic,three infra renal aortic, and three iliac arteries) and two thoracic (aortic arch). In all three remaining patients, there was a pre-existing arteriosclerotic aneurysm (fusiform) and only incipient changes were observed in the adjacent fat. Perianeurysmatic soft-tissue was was noted in eight cases. Only two patients presented signs of tear (peri aneurysm hematoma and/or with contrast extravasation). In three cases, the calcium ring was disrupted. In two patients, absences were observed in other locations. In none of the cases was there gas in the aneurysm wall. Mycotic aneurysm is a rate entity, but must be considered in the evaluation of septic patients since it demands early diagnosis and treatment. In such patients, a CT finding of saccular aneurysm with adjacent soft-tissue mass, and associated with a positive hemo culture, is highly suggestive of this pathology. (Author) 9 refs.

  10. Endovascular strategy for unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mangiafico, S., E-mail: mangiax@libero.it [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Guarnieri, G., E-mail: gianluigiguarnieri@hotmail.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Consoli, A., E-mail: onemed21@gmail.com [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Ambrosanio, G., E-mail: gambros@libero.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy)

    2013-10-01

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA.

  11. Avaliação pós-operatória do tratamento endovascular de aneurismas da aorta abdominal por angiotomografia com multidetectores Post-operative evaluation of endovascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Fabiana Barroso Thomaz

    2008-08-01

    Full Text Available OBJETIVO: Este estudo tem como objetivo a avaliação pós-operatória do tratamento endovascular de aneurismas da aorta abdominal por angiotomografia com multidetectores. MATERIAIS E MÉTODOS: Foram analisadas, retrospectivamente, angiotomografias de 166 pacientes (137 homens e 29 mulheres com idade média de 73 anos portadores de aneurisma da aorta abdominal submetidos a terapêutica endovascular, no período de junho de 2005 a agosto de 2006. Os exames foram feitos em tomógrafo multidetector de 64 canais e os parâmetros adotados foram: colimação, 0,625 mm; pitch, 0,6-1; mAs, 300-400; kV, 120. Em todos os casos foi utilizado meio de contraste iodado não-iônico (350 mg/ml administrado por meio de bomba infusora, com fluxo de 4 ml/s a 5 ml/s e com volume variável de 70 ml a 100 ml. Os exames foram avaliados quanto à presença de complicações. RESULTADOS: Dos 166 exames realizados, 93 pacientes não apresentaram complicações e 73 apresentaram os seguintes achados: endoleak (n=37, trombose circunferencial da endoprótese (n=29, angulação (n=17, coleção no sítio de punção (n=10, migração da prótese (n=7, dissecção dos vasos de acesso (n=7 e oclusão (n=6. CONCLUSÃO: O endoleak foi a complicação mais prevalente em nosso estudo, sendo o tipo II o mais comum.OBJECTIVE: The present study was aimed at evaluating endovascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography. MATERIALS AND METHODS: Multidetector computed tomography angiography studies of 166 patients were retrospectively analyzed. The sample included 137 men and 29 women with mean age of 73 years who had undergone endovascular treatment for abdominal aortic aneurysm in the period between June 2005 and August 2006. Images were acquired in a 64-channel multidetector tomograph adopting the following parameters: 0.625 mm collimation, pitch 0.6-1, 300-400 mAs, and 120 kV. A nonionic iodinated contrast agent (350 mg/ml was injected

  12. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Visser, J.J.; Williams, M.A.; Kievit, J.; Bosch, J.L.; Hunink, M.G.M.; Teijink, J.A.; Verhoeven, E.L.; Smet, A.A. de; Geelkerken, R.H.; Steyerberg, E.W.; Sambeek, M.R. van

    2009-01-01

    OBJECTIVE: To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surg

  13. Endoscope-assisted microneurosurgery for intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Renato Juan Galzio

    2013-12-01

    Full Text Available Background:The endovascular techniques has widely changed the treatment of intracranial aneurysms.However surgery still represent the best therapeutic option in case of broad-based and complex lesions.The combined use of endoscopic and microsurgical techniques (EAM may improve surgical results. Objective:The purpose of our study is to evaluate the advantages and limits of EAM for intracranial aneurysms.Methods:Between January 2002 and December 2012,173 patients,harbouring 206 aneurysms were surgically treated in our department with the EAM technique.157 aneurysms were located in the anterior circulation and 49 were in the posterior circulation.Standard tailored approaches,based on skull base surgery principles,were chosen.The use of the endoscope included three steps:initial inspection,true operative time and final inspection.For each procedure,an intraoperative video and an evaluation schedule were prepared,to report surgeons’ opinions about the technique itself.In the first cases,we always used the endoscope during surgical procedures in order to get an adequate surgical training.Afterwards we became aware in selecting cases in which to apply the endoscopy,as we started to become familiar with its advantages and limits.Results:After clipping,all patients were undergone postoperative cerebral angiography.No surgical mortality related to EAM were observed.Complications directly related to endoscopic procedures were rare.Conclusions:Our retrospective study suggests that endoscopic efficacy for aneurysms is only scarcely influenced by the preoperative clinical condition (Hunt-Hess grade,surgical timing,presence of blood in the cisterns (Fisher grade and/or hydrocephalus.However the most important factors contributing to the efficacy of EAM are determined by the anatomical locations and sizes of the lesions.Furthermore,the advantages are especially evident using dedicated scopes and holders,after an adequate surgical training to increase the

  14. Pediatric intracranial aneurysms.

    Science.gov (United States)

    Tripathy, L N; Singh, S N

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult counterparts. We present four such cases from our own experience. All these children were operated upon, where the solitary aneurysm in each case was clipped and all of them made a good recovery.

  15. Mirror aneurysms : a reflection on natural history

    NARCIS (Netherlands)

    Meissner, Irene; Torner, James; Huston III, John; Rajput, Michele L.; Wiebers, David O.; Jones, Lyell K.; Brown, Robert D.; Groen, Rob

    2012-01-01

    OBJECT: Investigators conducting the International Study of Unruptured Intracranial Aneurysms, sponsored by the National Institutes of Health, sought to evaluate predictors of future hemorrhage in patients who had unruptured mirror aneurysms. These paired aneurysms in bilateral arterial positions mi

  16. Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease.

    Science.gov (United States)

    Daou, Badih; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Rosenwasser, Robert H; Jabbour, Pascal

    2015-10-01

    We report a woman who presented with an intraparenchymal hemorrhage. Her cerebral angiogram showed a middle cerebral artery (MCA) M1 occlusion with multiple collaterals supplying the distal MCA territory, compatible with moyamoya disease. Also, an associated 8 mm dysplastic distal aneurysm fed by a left-sided P2 perforator was seen, collateral from the posterior cerebral artery. The aneurysm was successfully occluded with Onyx (ev3 Endovascular, Plymouth, MN, USA) embolization. The woman had an uneventful postoperative course. Aneurysm formation in patients with moyamoya disease represents a major hemorrhagic risk. Several treatment strategies exist including endovascular and surgical approaches. Patients with moyamoya disease who present with aneurysmal intracerebral hemorrhage should be treated to prevent rebleeding. Onyx embolization can be an effective treatment of aneurysms that are associated with moyamoya disease and would otherwise be difficult to treat surgically.

  17. Posterior reduction and internal fixation with posterior cranial fossa cranioectomy decompression for Chiari malformation type Ⅰ with basilar invagination, atlantoaxial subluxation, and syringomyelia

    Directory of Open Access Journals (Sweden)

    HU Peng

    2012-08-01

    Full Text Available Background Chiari malformation type Ⅰ(CM-Ⅰ is one of the soft tissue anomalies in craniovertebral junction (CVJ. This kind of soft tissue anomaly usually develops with bone anomaly, such as atlantoaxial subluxation, basilar invagination, platybasia, C1 assimilation, etc. For these complex combined anomalies, the treatment remains unaddressed. This study was performed to evaluate the effect of posterior reduction and internal fixation with posterior cranial fossa cranioectomy decompression for Chiari malformation type Ⅰ with basilar invagination, atlantoaxial subluxation, and syringomyelia. Methods Patients with basilar invagination and atlantoaxial subluxation treated from July 2004 to September 2011 were reviewed. Including criterions were made to screen matching patients. Including patients were retrospectively analyzed on both clinical outcomes and radiographical results. Japanese Orthopaedic Association (JOA score was used to evaluate the clinical outcomes, while the syrinx maximum size was measured on transverse view of MRI T2 image. The results were analyzed by SPSS 17.0 using t -text. Significant difference was considered when P ≤ 0.05. Results Fourteen patients met the including criterions, including 4 male patients and 10 female patients, with a mean age of 31.86 ± 11.36 (standard deviation, range: 17-51 years. Mean JOA score preoperatively of 14 patients was 13.07 ± 1.59 (standard deviation, while that was 15.57 ± 1.02 (standard deviation postoperatively (t = 9.946, P = 0.000. The mean syrinx size was (7.05 ± 1.98 mm (standard deviation, while that was (2.21 ± 1.91 mm (standard deviation postoperatively (t = 7.271, P = 0.000. There were no procedure-related morbidity or mortality happened. Conclusion Direct posterior reduction and internal fixation with posterior cranial fossa cranioectomy decompression can obviously improve the clinical outcomes and shrink syrinx for patients suffered from Chiari malformation typeⅠ with

  18. Unoperated aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Nørgaard, M; Herzog, T M;

    1995-01-01

    From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable...... hypertension were predictive of mortality, whereas...

  19. Screening for aortic aneurysm after treatment of coarctation.

    Science.gov (United States)

    Hoffman, James L; Gray, Robert G; LuAnn Minich, L; Wilkinson, Stephen E; Heywood, Mason; Edwards, Reggie; Weng, Hsin Ti; Su, Jason T

    2014-01-01

    Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the

  20. Three-dimensional printing technology for treatment of intracranial aneurysm

    Institute of Scientific and Technical Information of China (English)

    Yin Kang; LiangHong Yu; Tao Xu; ShuFa Zheng; PeiSen Yao; Man Liu; YuanXiang Lin

    2016-01-01

    Background:The development of three-dimensional (3D) printing technology provides a new method for surgical treatment,but currently there are few reports on its application in the treatment of aneurysm.The aim of the present study was to explore the materials and methods of fabricating 3D printed individual aneurysm model and its value in the treatment of intracranial aneurysm.Methods:Twenty-four patients with intracranial aneurysm diagnosed by CTA who had undergone operation in our hospital were analyzed retrospectively.CTA Data collected at the time of surgery was used for reconstruction.Soft Mimics 17.0 was used to reconstruct the thin layer CTA scan data into 3D image and the final data was sent to the 3D printer for fabricating the model.We compared the proposed 3D printed model-based preoperative plan and the actual approach used in the surgery based on CTA data to evaluate the value of the 3D printed model in preoperative planning,and picked out the materials which were more suitable for the clinic.Results:Twenty-four aneurysm models with high degree of reality were fabricated successfully with 3D-printing technology.The patients' blood vessels,skulls and aneurysms were printed into the reality model at a ratio of 1:1.It is reported that the soft material-based,3D printed vascular and aneurysm model more closely resembled the characteristics of the real blood vessels,thus provides a better simulation compared to the plaster-based model.Compared with the original operation plan,3D printed model could be used for pre-operative aneurysm clip selection,and provide more intuitive information in selection of operational approach.Conclusions:3D printed model can be used as an operational physical model to design operative schemes,choose the best operative paths and select suitable aneurysm clips by its high simulation degree and individualized characteristics.The model is helpful for surgical planning,especially for the preoperative plan of treating refractory

  1. Surgical management of large and giant intracavernous and paraclinoid aneurysms

    Institute of Scientific and Technical Information of China (English)

    Xu Bai-nan; SUN Zheng-hui; JIANG Jin-li; WU Chen; ZHOU Ding-biao; YU Xin-guang; LI Bao-min

    2008-01-01

    Background Due to their location,large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons.We identified characteristics.surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used.The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression.Paraclinoid aneurysms were directly clipped,intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft.Intraoperative electroencephaIogram (EEG) and somatosensory evoked potential (SSEP) monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries.Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels.Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms.Postoperative digital subtraction angiography (DSA) was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped,1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascula rization.Except for two patients who died in the early postoperative stage,34 patients' follow-up was 6-65 months (mean 10 months)and a Glasgow Outcome Scale score of 4 to 5 at discharge.At the 6-month follow-up examination,Rankin Outcome Scale scores were 0 to 2 in 32 patients.EEG and SSEP monitoring changed in six patients.Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected.Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms.The temporary parent vessel occlusion

  2. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Su Young; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Choi, Sang Tae; Park, Jae Hyung [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  3. Segmented Coronary Artery Aneurysms and Kawasaki Disease

    Directory of Open Access Journals (Sweden)

    Hamid Reza Ghaemi

    2011-05-01

    Full Text Available Kawasaki disease (KD is an acute vasculitis syndrome of unknown etiology. It occurs in infants and young children,affecting mainly small and medium-sized arteries, particularly the coronary arteries. Generalized microvasculitis occurs in the first 10 days, and the inflammation persists in the walls of medium and small arteries, especially the coronary arteries, and changes to coronary artery aneurysms.We report the case of a 10-month-old girl referred to our center three months after the onset of disease due to the aneurysmsof the coronary arteries. During the acute phase of her illness, she received 2 gr/kg intravenous gamma globulin; and afterher referral to us, the patient was treated by antiaggregant doses of acetylsalicylic acid (ASA (5 mg/kg and Warfarin (1 mg/daily. At three months’ follow-up, the aneurysms still persisted in the echocardiogram.

  4. Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

    Science.gov (United States)

    Martinez Santos, Jaime; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

    2016-07-01

    Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.

  5. Successful endovascular reconstruction of a recurrent giant middle cerebral artery aneurysm with multiple telescoping flow diverters in a pediatric patient.

    Science.gov (United States)

    Ikeda, Daniel S; Marlin, Evan S; Shaw, Andrew; Powers, Ciarán J

    2015-01-01

    Intracranial aneurysms of the pediatric population are rare, but giant fusiform aneurysms (GFAs) of the middle cerebral artery (MCA) are common within this cohort of patients. These aneurysms are difficult to treat and often require advanced microsurgical skills, as they are usually not amenable to direct clipping. Here, we report the successful treatment of a recurrent GFA of the MCA with three telescoping Pipeline Embolization Devices 6 months after attempted clip reconstruction in a pediatric patient.

  6. Hair cell force generation does not amplify or tune vibrations within the chicken basilar papilla.

    Science.gov (United States)

    Xia, Anping; Liu, Xiaofang; Raphael, Patrick D; Applegate, Brian E; Oghalai, John S

    2016-10-31

    Frequency tuning within the auditory papilla of most non-mammalian species is electrical, deriving from ion-channel resonance within their sensory hair cells. In contrast, tuning within the mammalian cochlea is mechanical, stemming from active mechanisms within outer hair cells that amplify the basilar membrane travelling wave. Interestingly, hair cells in the avian basilar papilla demonstrate both electrical resonance and force-generation, making it unclear which mechanism creates sharp frequency tuning. Here, we measured sound-induced vibrations within the apical half of the chicken basilar papilla in vivo and found broadly-tuned travelling waves that were not amplified. However, distortion products were found in live but not dead chickens. These findings support the idea that avian hair cells do produce force, but that their effects on vibration are small and do not sharpen tuning. Therefore, frequency tuning within the apical avian basilar papilla is not mechanical, and likely derives from hair cell electrical resonance.

  7. A Brownian Energy Depot Model of the Basilar Membrane Oscillation with a Braking Mechanism

    CERN Document Server

    Zhang, Yong; Lee, Kong-Ju-Bock; Park, Youngah

    2008-01-01

    High auditory sensitivity, sharp frequency selectivity, and otoacoustic emissions are signatures of active amplification of the cochlea. The human ear can also detect very large amplitude sound without being damaged as long as the exposed time is not too long. The outer hair cells are believed as the best candidate for the active force generator of the mammalian cochlea. In this paper, we propose a new model for the basilar membrane oscillation which successfully describes both the active and the protective mechanisms by employing an energy depot concept and a critical velocity of the basilar membrane. One of the main results is that thermal noise in the absence of external stimulation can be amplified leading to the spontaneous basilar membrane oscillation. The compressive response of the basilar membrane at the characteristic frequency and the dynamic response to the stimulation are consistent with the experimental results as expected. Our model also shows the nonlinear distortion of the response of the bas...

  8. Safety and Feasibility of Simultaneous Ipsilateral Proximal Carotid Artery Stenting and Cerebral Aneurysm Coiling

    Directory of Open Access Journals (Sweden)

    Aamir Badruddin

    2010-10-01

    Full Text Available Background: Coexistence of cerebral aneurysm and carotid artery disease may be encountered in clinical practice. Theoretical increase in aneurysmal blood flow may increase risk of rupture if carotid artery disease is treated first. If aneurysm coiling is performed first, stroke risk may increase while repeatedly crossing the diseased artery. It is controversial which disease to treat first, and whether it is safe to treat both simultaneously via endovascular procedures. We document the safety and feasibility of such an approach. Methods: Review of collected neurointerventional database at our institution was performed for patients who underwent both Carotid artery stenting (CAS and aneurysm coil embolization (ACE simultaneously. All patients underwent carotid stenting followed by aneurysm coiling in the same setting. Demographic, clinical data and outcome measures including success rate and periprocedural complications were collected. Results: 590 aneurysms coiling were screened for patients who underwent combined CAS and ACE. Ten patients were identified. Mean age was 67.7 years (range 51 to 89. The success rate for stenting and coiling was 100% with no immediate complications. No stroke, TIAs, or aneurysmal rebleeding was found on their most recent follow up. Conclusions: Our case series demonstrates that it is safe and feasible to perform CAS and ACE simultaneously as one procedure which may avoid unwanted risk of treating either disease at two separate time sessions.

  9. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J;

    1998-01-01

    The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

  10. Endovascular conversion with femorofemoral bypass as a treatment of endotension and aneurysm sac enlargement.

    Science.gov (United States)

    Smith, Stephen T; Clagett, G Patrick; Arko, Frank R

    2007-02-01

    We report a case of a patient treated with a Gore Excluder endograft for AAA in November 2003 with subsequent aneurysm sac enlargement in the absence of an identified endoleak. The patient had a Type I endoleak treated with a Palmaz stent at the neck and later developed a Type II endoleak treated with translumbar coil embolization. This was successful with absence of pressure in the sac after the procedure and stable aneurysm size over the next nine months. Surveillance of the patient with both CT and ultrasound then revealed an increase in the aortic sac diameter in the absence of endoleak. A Cook Zenith converter was used to reline this PTFE endograft. Subsequently, imaging showed aneurysm sac shrinkage. This is a report of endotension with aneurysm expansion following Gore Excluder placement which was treated successfully with a dacron endograft.

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

    Energy Technology Data Exchange (ETDEWEB)

    Cirillo, Mario, E-mail: mario.cirillo@unina2.it [Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences – 2nd University of Naples (Italy); Scomazzoni, Francesco [Department of Neuroradiology, Scientific Institute San Raffaele, Milan (Italy); Cirillo, Luigi [IRCCS – Institute of Neurological Sciences, Bologna (Italy); Cadioli, Marcello; Simionato, Franco; Iadanza, Antonella [Department of Neuroradiology, Scientific Institute San Raffaele, Milan (Italy); Kirchin, Miles [Worldwide Medical and Regulatory Affairs, Bracco Imaging SpA, Milan (Italy); Righi, Claudio; Anzalone, Nicoletta [Department of Neuroradiology, Scientific Institute San Raffaele, Milan (Italy)

    2013-12-01

    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

  12. Successful endovascular treatment of a growing megadolichoectasic vertebrobasilar artery aneurysm by flow diversion using the "diverter-in-stent" technique.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Itshayek, Eyal

    2012-01-01

    Giant dolichoectatic and fusiform aneurysms of the vertebrobasilar artery are among the most difficult and dangerous aneurysms to treat. Conservative management may be reasonable in asymptomatic elderly patients. Nevertheless, due to the frequent presence of mass effect on the brainstem and the risks of thromboembolic events and rupture, these aneurysms often demand treatment rather than observation. With the advancement of endovascular techniques some of these lesions have become treatable without the high morbidity and mortality rates associated with open surgical treatment. When dealing with giant, progressively enlarging symptomatic aneurysms, more limited therapeutic alternatives are available. The authors present a case of a growing megadolichoectatic vertebrobasilar artery aneurysm causing major disability due to increasing mass effect in a 51-year-old man. The aneurysm was treated with flow diversion by placing multiple telescoped stents and diverters ("diverter-in-stent" technique), achieving thrombosis of the aneurysm and reduction of the mass effect on the brainstem, with neurological improvement. The successful clinical and angiographic results observed in our case of giant dolichoectasic vertebrobasilar aneurysm contribute to the literature on giant aneurysms treated by means of flow diversion.

  13. CT of thoracic aortic aneurysms.

    Science.gov (United States)

    Posniak, H V; Olson, M C; Demos, T C; Benjoya, R A; Marsan, R E

    1990-09-01

    Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.

  14. Coil migrating out of a small wide-necked aneurysm embolized with stent-assisted technique

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Stent-assisted coiling is one of the techniques used to treat intracranial aneurysms with wide necks or unfavorable neck-to-fundus ratios, which have been traditionally considered as poor candidates for Guglielmi detachable coil ( GDC ) embolization owing to the significant risk of coil herniation into the parent artery[1-5]. With this technique, fusiform, wide-necked and geometrically difficult aneurysms as well as pseudoaneurysms have been successfully treated with different follow-up results. Herein, we present an aneurysm case with a coil escaping from the confinement of the stent.

  15. 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

  16. Evaluation of Large Intracranial Aneurysms with Cine MRA and 3D Contrast-Enhanced MRA

    Institute of Scientific and Technical Information of China (English)

    朱文珍; 冯定义; 漆剑频; 夏黎明; 王承缘

    2004-01-01

    Summary: The value of combined application of both ECG-gated cine MRA and 3D-CEMRA in the detection of large intracranial aneurysms was evaluated and the findings were compared with those of conventional MRA and DSA. Twenty-four patients with 26 large intraeranial aneurysms underwent MRI and DSA. All these aneurysms, diameter from 15 to 39 mm, were located at internal cerebral artery (n = 12), vertebral artery (n = 3), basilar artery (n = 4), anterior cerebral artery (n =2), middle cerebral artery (n=2), anterior communicate artery (n=2) and posterior communicate artery (n= 1). Thirteen cases of hematoma or cavernoma were studied as control group. All patients were examined on GE 1.5T MR system. ECG-gated eine MRA was performed with 2D multi-phase fast gradient-recalled echo sequence in a single section. All the images were analyzed with signal intensity VS time curve for differentiating intraaneurysmal blood flow from static tissue.The results were analzsed by statistic "t" test. 3D-CEMRA was performed with spoiled gradient-recalled echo and one dose of Gd-DTPA. All data was processed with multi-plannar reformat (MPR)and tomography for the demonstration of aneurysms in detail. All 26 aneurysms were demonstrated successfully by combined application of both cine MRA and 3D-CEMRA. Compared to DSA and conventional 3D-MOTSA, its sensitivity and specificity figures were both 100 %. Cine MRA could differentiate the blood flow from the static tissue. The intensity VS time curves of intraaneurysmal blood flow offered fluctuating form and average signal change between systole and diastole period was about 89.8±37.4; However, under the control group, intraaneurysmal thrombus or cerebral hemorrhage or eavernomas had no significant signal change and the curves offered steady form with the average signal change being about 8.2 ± 6. 3. There was statistically significant difference between the intraaneurysmal blood flow and static tissue (P= 0. 025, <0.05). 3D-CEMRA was very

  17. Flow modification in canine intracranial aneurysm model by an asymmetric stent: studies using digital subtraction angiography (DSA) and image-based computational fluid dynamics (CFD) analyses

    Science.gov (United States)

    Hoi, Yiemeng; Ionita, Ciprian N.; Tranquebar, Rekha V.; Hoffmann, Kenneth R.; Woodward, Scott H.; Taulbee, Dale B.; Meng, Hui; Rudin, Stephen

    2006-03-01

    An asymmetric stent with low porosity patch across the intracranial aneurysm neck and high porosity elsewhere is designed to modify the flow to result in thrombogenesis and occlusion of the aneurysm and yet to reduce the possibility of also occluding adjacent perforator vessels. The purposes of this study are to evaluate the flow field induced by an asymmetric stent using both numerical and digital subtraction angiography (DSA) methods and to quantify the flow dynamics of an asymmetric stent in an in vivo aneurysm model. We created a vein-pouch aneurysm model on the canine carotid artery. An asymmetric stent was implanted at the aneurysm, with 25% porosity across the aneurysm neck and 80% porosity elsewhere. The aneurysm geometry, before and after stent implantation, was acquired using cone beam CT and reconstructed for computational fluid dynamics (CFD) analysis. Both steady-state and pulsatile flow conditions using the measured waveforms from the aneurysm model were studied. To reduce computational costs, we modeled the asymmetric stent effect by specifying a pressure drop over the layer across the aneurysm orifice where the low porosity patch was located. From the CFD results, we found the asymmetric stent reduced the inflow into the aneurysm by 51%, and appeared to create a stasis-like environment which favors thrombus formation. The DSA sequences also showed substantial flow reduction into the aneurysm. Asymmetric stents may be a viable image guided intervention for treating intracranial aneurysms with desired flow modification features.

  18. Endovascular treatment of intracranial aneurysms using coil embolization plus an Enterprise stent

    Institute of Scientific and Technical Information of China (English)

    XU Xiang; SHANG Xiao-ming; CUI Jian-zhong; WANG Da-yong

    2011-01-01

    Background Several difficulties can arise from wide-neck cerebral aneurysms when treated with endovascular embolization. We aimed to investigate the effect of endovascular treatment of intracranial aneurysms using coil embolization plus an Enterprise stent.Methods Forty patients were treated with coil embolization plus an Enterprise stent between December 2008 and June 2010.Results The mortality of patients was 0. All stents were successfully implanted without any surgery-related complication.Conclusion The Enterprise stent has some advantages to be selected.

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

    Energy Technology Data Exchange (ETDEWEB)

    Taschner, Christian A. [University Hospital Lille, Department of Neuroradiology, Hopital Roger Salengro, Lille (France)]|[C.H.R.U. de Lille, Service de Neuroradiology, Hopital Roger Salengro, LILLE Cedex (France); Thines, Laurent; Lejeune, Jean-Paul [University Hospital Lille, Department of Neurosurgery, Hopital Roger Salengro, Lille (France); El-Mahdy, Mohamed [University Hospital Lille, Department of Neuroradiology, Hopital Roger Salengro, Lille (France)]|[Cairo University, Department of Neurology, Faculty of Medicine, Cairo (Egypt); Rachdi, Henda; Gauvrit, Jean-Yves; Pruvo, Jean-Pierre; Leclerc, Xavier [University Hospital Lille, Department of Neuroradiology, Hopital Roger Salengro, Lille (France)

    2009-01-15

    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.)

  20. Extracranial to intracranial bypass for the treatment of cerebral aneurysms in the pediatric population.

    Science.gov (United States)

    Strickland, Ben A; Attenello, Frank; Russin, Jonathan J

    2016-12-01

    Cerebral aneurysms are rare in the pediatric population, making a definitive treatment algorithm difficult. Microsurgical clipping is the first choice for treatment but is not always feasible, while high recurrence rates and radiation exposure make endovascular options less favorable. Extracranial-intracranial (EC-IC) bypass, though not commonly performed in the pediatric aneurysm population, has been reported in a small number of studies to be both safe and effective for the management of cerebral aneurysms. The authors present the case of a child with a distal middle cerebral artery (MCA) aneurysm in eloquent territory, successfully treated with a superficial temporal artery (STA) to MCA bypass and trapping. A review of the current literature on pediatric EC-IC bypass in the treatment of intracranial aneurysms is presented.

  1. A Case Report: Balloon Occlusion Of Vertebral Artery In A Giant Vertebral Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    K. Edraki

    2005-08-01

    Full Text Available Introduction & Background: True aneurysms of extra cranial vertebral arteries are rare. The usual pathogenesis of aneurysms in this location is either penetrating or blunt trauma with resultant pseudo- aneurysm formation. We report a patient with a presumed pseudo-aneurysm of the extra- cranial vertebral artery presenting with painful neck mass, without obvious history of trauma. Case description: A 59-year old man presented with painful left lateral neck mass from 3 month ago with a bruit over it on physical examination. Patient had a history of long term anticoagulant therapy because of chronic lower extremity DVT. Patient was referred to our DSA (Department for angiography. After color Doppler US, CT scan and MR-angiography were performed and a giant aneurysm in left vertebral artery was detected. The lesion was successfully treated by an endovascular technique of balloon occlusion of the verte-bral artery.

  2. In vivo response to an implanted shape memory polyurethane foam in a porcine aneurysm model.

    Science.gov (United States)

    Rodriguez, Jennifer N; Clubb, Fred J; Wilson, Thomas S; Miller, Matthew W; Fossum, Theresa W; Hartman, Jonathan; Tuzun, Egemen; Singhal, Pooja; Maitland, Duncan J

    2014-05-01

    Cerebral aneurysms treated by traditional endovascular methods using platinum coils have a tendency to be unstable, either due to chronic inflammation, compaction of coils, or growth of the aneurysm. We propose to use alternate filling methods for the treatment of intracranial aneurysms using polyurethane-based shape memory polymer (SMP) foams. SMP polyurethane foams were surgically implanted in a porcine aneurysm model to determine biocompatibility, localized thrombogenicity, and their ability to serve as a stable filler material within an aneurysm. The degree of healing was evaluated via gross observation, histopathology, and low vacuum scanning electron microscopy imaging after 0, 30, and 90 days. Clotting was initiated within the SMP foam at time 0 (<1 h exposure to blood before euthanization), partial healing was observed at 30 days, and almost complete healing had occurred at 90 days in vivo, with minimal inflammatory response.

  3. Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

    Directory of Open Access Journals (Sweden)

    Hidetoshi Ooigawa

    2015-06-01

    Full Text Available We report a case of small internal carotid–posterior communication artery (IC–PC aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated.

  4. Introduction of endovascular embolization for intracranial aneurysms in a low-volume institution

    DEFF Research Database (Denmark)

    Lindekleiv, H M; Jacobsen, E A; Kloster, R

    2009-01-01

    BACKGROUND: Studies indicate a relationship between hospital caseload and health outcomes after both surgical and endovascular repair of intracranial aneurysms. PURPOSE: To evaluate outcomes after introduction of endovascular embolization for intracranial aneurysms in a low-volume regional...... university hospital. MATERIAL AND METHODS: Retrospective study of 243 consecutive patients treated for 284 intracranial aneurysms with endovascular embolization or surgical clipping from 2000 to 2006 at the University Hospital of North Norway. Postoperative complications were registered. The Glasgow Outcome...... Scale (GOS) was used for assessment of outcome. RESULTS: The mean annual number of procedures was 39 (microsurgery 23, embolization 16). Seventy-four percent of patients with ruptured aneurysms and all patients with unruptured aneurysms had a favorable outcome (GOS 4 or 5) at 1 year follow-up. Patients...

  5. Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

    Directory of Open Access Journals (Sweden)

    Lampis C. Stavrinou

    2010-01-01

    Full Text Available Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge. Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine. Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion. Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.

  6. Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

    Directory of Open Access Journals (Sweden)

    Sepideh Amin-Hanjani

    2014-01-01

    Full Text Available Background: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery-middle cerebral artery bypass is another potential strategy for resolution of these aneurysms. Case Description: Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm. Conclusions: A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.

  7. Ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  8. Distal posterior cerebral artery aneurysms: Retrospective review of characteristics and endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jin Wook [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Bae Woong [Dept. of Diagnostic Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of); Seung, Won Bae [Dept. of Neurosurgery, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)

    2016-04-15

    The objective of this study was to review the clinical outcome after treatment of distal posterior cerebral artery (PCA) aneurysms via endovascular approach. Eleven patients with 11 distal PCA aneurysms who were treated via endovascular approach in Inje University Busan Paik Hospital and Kosin University Gospel Hospital from December 2002 to December 2013 were retrospectively reviewed. Among the 11 patients, there were 3 males (27.3%) and 8 females (72.7%). The mean age was 56.6 years (range 44 -72 years) and the mean aneurysm size was 8.45 mm (3 - 30 mm). Four (36.4%) aneurysms were located in the P2 segment, 6 (54.5%) in the P3 segment and 1 (9.1%) in the P1/2 junction. Seven (63.6%) aneurysms were treated with preservation of the parent artery; and the remaining 4 (36.4%) aneurysms were treated with parent artery occlusion. After treatment, the overall complication rate was 27% with the morbidity rate of 9.1% and the mortality rate of 18%. Endovascular treatment of distal PCA aneurysm might be used to minimize neurologic deficit, considering the diverse and rich collaterals of posterior cerebral artery.

  9. Local anesthesia for endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, ELG; Cina, CS; Tielliu, IFJ; Zeebregts, CJ; Prins, TR; Eindhoven, GB; Span, MM; Kapma, MR; van den Dungen, JJAM

    2005-01-01

    Objectives: This study reports the results of a prospective continuous cohort of patients treated for endovascular aneurysm repair (EVAR) with a unified anesthetic strategy based on the use of local anesthesia (LA) in all patients, while reserving regional (RA) or general anesthesia (GA) only for th

  10. [Pseudomembranous colitis after surgery for a ruptured abdominal aortic aneurysm].

    Science.gov (United States)

    Lozano Sánchez, F; Sánchez Fernández, J; Palacios, E; Fernández, M; Ingelmo Morin, A; Gómez Alonso, A

    1993-01-01

    We present a rare postoperative complication after surgical procedures for rupture of abdominal aortic aneurysms. The disease, a pseudomembranous colitis, was early recognized (by evidence of clostridium difficile after a coprocultive) and satisfactorily treated with vancomycin. From the literature review we found only a similar case but results were absolutely different from our case.

  11. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    Science.gov (United States)

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  12. Endovascular treatment of unruptured posterior circulation intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xianli Lv

    2016-01-01

    Full Text Available Background and Purpose: Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA. The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs. Materials and Methods: Retrospective analysis of all patients treated in a 2-year period (89 patients: 10-78 years of age, mean: 45.5 ± 14.3/92 UPCIAs. Fifty-eight aneurysms were found incidentally, 12 in association with mass effect symptoms and 22 with stroke. Results: A clinical improvement or stable outcome was achieved in 84 patients (94.4%. The two cases of permanent morbidity included a patient with paralysis and another patient with hemianopia. One patient died after treatment of a giant fusiform vertebrobasilar aneurysm. In one patient, the aneurysm ruptured during treatment, resulting in death. Another patient suffered a fatal aneurysm rupture 4 days after treatment. Giant size (P = 0.005 and mass effect presentation (P = 0.029 were independent predictors of unfavorable outcomes in UPCIAs. Angiographic follow-up was available in 76 of the 86 surviving patients (88.4% with a mean of 6.8 months (range: 1-36 months. Recanalization in six patients (7.9% at 3 months, 4 months, 4 months, 24 months, and 36 months required retreatment in three patients. In-stent stenosis of >50% was found in three patients. Conclusion: Endovascular therapy is an attractive option for UPCIAs with stable midterm outcome. However, the current endovascular option seems to have a limitation for the treatment of the aneurysm with giant size or mass effect presentation.

  13. 复杂颅内动脉瘤的介入治疗%Interventional Therapy of Complex Intracranial Aneurysms

    Institute of Scientific and Technical Information of China (English)

    王军民

    2012-01-01

    复杂颅内动脉瘤为一相对性概念,其复杂程度与患者自身因素及所选治疗方式有关,介入治疗之复杂颅内动脉瘤主要包括宽颈动脉瘤、不规则动脉瘤、巨大动脉瘤、微小动脉瘤、假性动脉瘤、多发动脉瘤和与颅内其他血管病变伴发之动脉瘤.随着颅内支架、球囊、Onyx等辅助材料和技术的发展,大多数复杂颅内动脉瘤可以选择介入治疗,但介入治疗不能治愈所有的颅内动脉瘤,并非所有的颅内动脉瘤都适合于介入治疗,介入治疗也不应该成为颅内动脉瘤唯一的治疗选择.%Complex intracranial aneurysm is a relative concept. The complexity is determined by factors related to patients and the method of therapy which has been chosen. As to interventional therapy, complex intracranial aneurysms mainly include wide—neck aneurysms, irregular aneurysms, large aneurysms, small aneurysms, pseudo aneurysms, multiple aneurysms and aneurysms with other intracranial vascular diseases. With development of intracranial stent, balloon, Onyx and other adjunctive material, most complex intracranial aneurysms can be treated by interventional technique, but interventional technique cannot cure all the intracranial aneurysms, not all the intracranail aneurysms are suitable for interventional technique, and interventional technique is not the only method of therapy for intracranial aneurysms.

  14. Semi-Jailing Technique Using a Neuroform3 Stent for Coiling of Wide-Necked Intracranial Aneurysms

    Science.gov (United States)

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

    2017-01-01

    Objective The semi-jailing technique (SJT) provides stent-assisted remodeling of the aneurysm neck during coil embolization without grasping the coil delivery microcatheter. We retrospectively evaluated the efficacy and safety of SJT using a Neuroform3 stent for coiling of wide-necked intracranial aneurysms. Methods We collected the clinical and radiological data between January 2009 and June 2015 of the wide-necked aneurysms treated with SJT using a Neuroform3 stent. Results SJT using a Neuroform3 stent was attempted in 70 wide-necked aneurysms (68 patients). There were 56 unruptured and 14 ruptured aneurysms. The size of aneurysm ranged from 1.7 to 28.1 mm (mean 6.1 mm). The immediate angiographic results were complete occlusion in 55 aneurysms (78.6%), neck remnant in 7 (10.0%), and aneurysm remnant in 8 (11.4%). Overall, periprocedural complications occurred in 13 patients (19.1%), including asymptomatic thromboembolism in 7 (10.3%), symptomatic thromboembolism in 4 (5.9%), and symptomatic hemorrhagic complications in 2 (2.9%). Conventional angiography follow-up was obtained in 55 (78.6%) of 70 aneurysms (mean, 10.9 months). The result showed progressive occlusion in 7 aneurysms (12.7%) and recanalization in 1 aneurysm (1.8%). At the end of the observation period (mean, 17.5 months), all 54 patients without subarachnoid hemorrhage showed excellent clinical outcomes (modified Rankin Scale [mRS] 0), except two (mRS 1 or 2) and seven of 14 patients with subarachnoid hemorrhage remained symptom-free (mRS 0). Conclusion In this report of 70 aneurysms, SJT using a Neuroform3 stent for coiling of wide-necked intracranial aneurysms showed good technical safety, as well as favorable clinical and angiographic outcomes. PMID:28264234

  15. Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms

    Directory of Open Access Journals (Sweden)

    Hitoshi Fukuda

    2014-01-01

    Full Text Available Background: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (ACoA aneurysms. Methods: Of the 70 cases of ruptured ACoA aneurysms between January 2006 and December 2013, our institutional experience revealed four cases of small ACoA aneurysms that had been considered clippable prior to operation but required trapping. When a unilateral A2 segment of anterior cerebral artery (ACA was compromised by trapping, revascularization was performed by bypass surgery. Clinical presentation, angiographic characteristics, operative approach, intraoperative findings, and treatment outcomes were assessed. Results: Very small aneurysm under 3 mm was a risk factor for unexpected trapping. The reason for unexpected trapping was laceration of the aneurysmal neck in two cases, and lack of clippaple component due to disintegration of entire aneurysmal wall at the time of rupture in the others. Aneurysms with bilateral A1 were treated with sole trapping through pterional approach in two cases. The other two cases had hypoplastic unilateral A1 segment of ACA and were treated with combination of aneurysm trapping and revascularization of A2 segment of ACA through interhemispheric approach. No patients had new cerebral infarctions of cortical ACA territory from surgery. Cognitive dysfunction was observed in three cases, but all patients became independent at 12-month follow up. Conclusions: Unexpected trapping was performed when ruptured ACoA aneurysms were unclippable. Trapping with or without bypass can result in reasonable outcomes, with acceptable risk of cognitive dysfunction.

  16. Platypnea-orthodeoxia induced by fenestrated atrial septal aneurysm.

    Science.gov (United States)

    Giombolini, Claudio; Notaristefano, Salvatore; Santucci, Stefano; Savino, Ketty; Pasquino, Stefano; Ragni, Temistocle; Ambrosio, Giuseppe

    2005-02-01

    Platypnea-orthodeoxia is a peculiar syndrome characterized by a right-to-left shunt, which occurs in the upright position. The diagnosis is made by contrast transesophageal echocardiography, paying attention to include contrast visualization in the orthostatic decubitus. The association of this syndrome with a fenestrated atrial septal aneurysm is rare and probably underlies a peculiar and also rare mechanism of shunting in presence of normal pulmonary pressure. We report of a case of a 58-year-old man with a fenestrated atrial septal aneurysm and platypnea-orthodeoxia syndrome treated by surgical closure of the atrial defect.

  17. Estimating overdiagnosis in Screening for Abdominal Aortic Aneurysm

    DEFF Research Database (Denmark)

    Johansson, Minna; Hansson, Anders; Brodersen, J.

    2015-01-01

    Clinical context: Abdominal aortic aneurysms (AAAs) are often asymptomatic until they rupture, when the death rate is greater than 80%. If diagnosed before rupture, AAA can be treated with surgery, which has a mortality of 4-5% Diagnostic change: Sweden, the UK, and the US have initiated screening...... programmes for AAA. There are also proposals to change the aortic diameter for diagnosis from ≥30 mm to 25 mm. Rationale for change: Early diagnosis by screening allows the opportunity of surgery to prevent ruptures Leap of faith—Detecting asymptomatic aneurysms will reduce AAA mortality and morbidity...

  18. 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

    INTRODUCTION: Since the flow diverters (FDs) have been introduced it is possible to treat aneurysms that are considered difficult or impossible to treat with usual endovascular or surgical methods. It is still uncertain which aneurysms are suitable for this new treatment. We present...... 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......-canalizations, and 11 patients were either untreated or had been treated for another aneurysm. RESULTS: Periprocedural complications were seen in four treatments (17%). However, none of these had clinical consequences. Mortality and morbidity rates were 1 of 22 (5%) and 1 of 22 (5%), respectively. Clinical outcome...

  19. Genetic and Epigenetic Regulation of Aortic Aneurysms

    Science.gov (United States)

    Kim, Ha Won

    2017-01-01

    Aneurysms are characterized by structural deterioration of the vascular wall leading to progressive dilatation and, potentially, rupture of the aorta. While aortic aneurysms often remain clinically silent, the morbidity and mortality associated with aneurysm expansion and rupture are considerable. Over 13,000 deaths annually in the United States are attributable to aortic aneurysm rupture with less than 1 in 3 persons with aortic aneurysm rupture surviving to surgical intervention. Environmental and epidemiologic risk factors including smoking, male gender, hypertension, older age, dyslipidemia, atherosclerosis, and family history are highly associated with abdominal aortic aneurysms, while heritable genetic mutations are commonly associated with aneurysms of the thoracic aorta. Similar to other forms of cardiovascular disease, family history, genetic variation, and heritable mutations modify the risk of aortic aneurysm formation and provide mechanistic insight into the pathogenesis of human aortic aneurysms. This review will examine the relationship between heritable genetic and epigenetic influences on thoracic and abdominal aortic aneurysm formation and rupture. PMID:28116311

  20. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    Science.gov (United States)

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2016-08-01

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  1. Glue embolization of ruptured anterior thalamoperforating artery aneurysm in patient with both internal carotid arteries occlusion.

    Science.gov (United States)

    Lee, Jae Il; Choi, Chang Hwa; Ko, Jun Kyeung; Lee, Tae Hong

    2011-05-01

    Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

  2. CFD-based Thrombotic Risk Assessment in Kawasaki Disease Patients with Coronary Artery Aneurysms

    Science.gov (United States)

    Sengupta, Dibyendu; Kung, Ethan; Kahn, Andrew; Burns, Jane; Marsden, Alison

    2012-11-01

    Coronary aneurysms occur in 25% of untreated Kawasaki Disease (KD) patients and put patients at increased risk for myocardial infarction and sudden death. Clinical guidelines recommend using aneurysm diameter >8 mm as the arbitrary criterion for treating with anti-coagulation therapy. This study uses patient-specific modeling to non-invasively determine hemodynamic parameters and quantify thrombotic risk. Anatomic models were constructed from CT angiographic image data from 5 KD aneurysm patients and one normal control. CFD simulations were performed to obtain hemodynamic data including WSS and particle residence times (PRT). Thrombosis was clinically observed in 4/9 aneurysmal coronaries. Thrombosed vessels required twice as many cardiac cycles (mean 8.2 vs. 4.2) for particles to exit, and had lower mean WSS (1.3 compared to 2.8 dynes/cm2) compared to vessels with non-thrombosed aneurysms of similar max diameter. 1 KD patient in the cohort with acute thrombosis had diameter < 8 mm. Regions of low WSS and high PRT predicted by simulations correlated with regions of subsequent thrombus formation. Thrombotic risk stratification for KD aneurysms may be improved by incorporating both hemodynamic and geometric quantities. Current clinical guidelines to assess patient risk based only on aneurysm diameter may be misleading. Further prospective study is warranted to evaluate the utility of patient-specific modeling in risk stratifying KD patients with coronary aneurysms. NIH R21.

  3. The role of Na(+), K(+)-ATPase in the hypoxic vasoconstriction in isolated rat basilar artery.

    Science.gov (United States)

    Shen, Haitao; Liang, Peng; Qiu, Suhua; Zhang, Bo; Wang, Yongli; Lv, Ping

    2016-06-01

    Hypoxia-induced cerebrovascular dysfunction is a key factor in the occurrence and the development of cerebral ischemia. Na(+), K(+)-ATPase affects the regulation of intracellular Ca(2+) concentration and plays an important role in vascular smooth muscle function. However, the potential role of Na(+), K(+)-ATPase in hypoxia-induced cerebrovascular dysfunction is unknown. In this study, we found that the KCl-induced contraction under hypoxia in rat endothelium-intact basilar arteries is similar to that of denuded arteries, suggesting that hypoxia may cause smooth muscle cell (SMC)-dependent vasoconstriction in the basilar artery. The Na(+), K(+)-ATPase activity of the isolated basilar artery with or without endothelium significantly reduced with prolonged hypoxia. Blocking the Na(+)-Ca(2+) exchanger with Ni(2+) (10(-3)M) or the L-type Ca(2+) channel with nimodipine (10(-8)M) dramatically attenuated KCl-induced contraction under hypoxia. Furthermore, prolonged hypoxia significantly reduced Na(+), K(+)-ATPase activity and increased [Ca(2+)]i in cultured rat basilar artery SMCs. Hypoxia reduced the protein and mRNA expression of the α2 isoform of Na(+), K(+)-ATPase in SMCs in vitro. We used a low concentration of the Na(+), K(+)-ATPase inhibitor ouabain, which possesses a high affinity for the α2 isoform. The contractile response in the rat basilar artery under hypoxia was partly inhibited by ouabain pretreatment. The decreased Na(+), K(+)-ATPase activity in isolated basilar artery and the increased [Ca(2+)]i in SMCs induced by hypoxia were partly inhibited by pretreatment with a low concentration of ouabain. These results suggest that hypoxia may educe Na(+), K(+)-ATPase activity in SMCs through the α2 isoform contributing to vasoconstriction in the rat basilar artery.

  4. A Clinical Study on the Effect of Yinxing Damo (银杏达莫) Combined with Betahistine Hydrochloride Injection on Vertebral Basilar Artery Ischemic Vertigo

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective: To evaluate the therapeutic efficacy of Yinxing Damo (银杏达莫, YXDM) combined with Betahistine Hydrochloride Injection (BHI) on vertebra basilar artery ischemic vertigo (VBIV).Methods: Ninety patients with VBIV were randomly divided into two groups; 45 patients (the treated group)were treated with YXDM and BHI intravenous dripping, once a day for 14 days. Another 45 patients (control clinical syndromes and the index of the transcranial Doppler (TCD) and hemorheology were observed. Results: The total effective rate was 100% in the treated group, which was better than that in the control group90.5%, (P<0.05). The indexes of TCD and hemorheology in the treated group were obviously improved after treatment, (P<0.01). Conclusion: YXDM combined with BHT injection had better effect in treating patients with VBIV is an ideal drug for VBIV.

  5. True aneurysm of brachial artery.

    Science.gov (United States)

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms.

  6. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

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

    2012-01-01

    General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic......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...

  7. Aneurisma da artéria cerebelar ântero-inferior: relato de caso Aneurysm of the anterior inferior cerebellar artery: case report

    Directory of Open Access Journals (Sweden)

    Juan Oscar Alarcón Adorno

    2002-12-01

    Full Text Available Os aneurismas intracranianos do sistema vértebro-basilar representam cerca de 5 a 10% de todos os aneurismas cerebrais. Os aneurismas da artéria cerebelar ântero-inferior (AICA são considerados raros, podendo causar síndrome do ângulo ponto cerebelar, com ou sem hemorragia subaracnóidea. Desde 1948, foram descritos poucos casos na literatura. Apresentamos o caso de uma paciente, de 33 anos, na qual, após investigação de quadro de hemorragia subaracnóidea, diagnosticou-se aneurisma sacular da AICA esquerda. Foi submetida a clipagem do aneurisma, com ótimo resultado pós operatório.The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA are considered rare, can cause cerebello pontine angle (CPA syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  8. Are active elements necessary in the basilar membrane impedance?

    Science.gov (United States)

    Diependaal, R J; Viergever, M A; de Boer, E

    1986-07-01

    This article is motivated by the current hypothesis [Kim et al., Psychological, Physiological and Behavioural Studies in Hearing (Delft U. P., The Netherlands, 1980); Neely, Doctoral dissertation, Washington University, St. Louis, MO (1981); de Boer, J. Acoust. Soc. Am. 73, 567-573 (1983a) and 73, 574-576 (1983b)] that it is necessary to include active elements in the basilar membrane (BM) impedance in order to explain recent data on the vibration of the BM [Khanna and Leonard, Science 215, 305-306 (1982); Sellick et al., J. Acoust. Soc. Am. 72, 131-141 (1982); Robles et al., Peripheral Auditory Mechanisms (Springer, New York, 1986)]. In order to test this hypothesis, first, a method which is an inversion of the customary description of cochlear mechanics is described. Instead of computing the BM velocity for a given point impedance of the membrane, we show how to compute the impedance function from a given BM velocity pattern in response to a sinusoidal input at the stapes. This method is then used to study the sensitivity of the recovered impedance to perturbations in the velocity pattern. The simulations used show that the real part of the impedance is extremely sensitive to such perturbations. Therefore, measured velocity patterns are unlikely to resolve the issue of whether active elements should be included. Frequency responses measured at a few points on the membrane are even less likely to do so.

  9. Surgery for rare aneurysm associated with colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Pei-Hua Lu; Guo-Qing Tao; Wei Shen; Bin Cai; Zhi-Yang Jiang; Jian Sun

    2009-01-01

    The occurrence of concomitant aortic aneurysm and colorectal cancer is a rare medical entity, and controversy surrounds its optimal treatment. We report a case of rectal cancer and concomitant aneurysm from the ascending aorta to the common iliac artery. As with DeBakey type Ⅰ aortic dissecting aneurysm, our patient was treated by rectal cancer resection, with preservation of the anus (Dixon operation) under controlled hypotension. Blood pressure was maintained at 80-90/ 50-60 mmHg and the pulse at 70-90 beats/min. The pathological examination of the surgical specimen showed a poorly differentiated T3N0 tumor. The patient had an uneventful recovery without aneurysm rupture, and was discharged from hospital on postoperative day 15 after 3 d adjuvant chemotherapy with oxaliplatin combined with calcium folinate and fluorouracil. The patient was given six courses of adjuvant chemotherapy in 6 mo, without recurrence or metastasis, and the aneurysm was still stable after 2 years follow-up.

  10. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    Science.gov (United States)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  11. Treatment of Complex Intracranial Aneurysms Using Flow-Diverting Silk® Stents

    Science.gov (United States)

    Buyukkaya, Ramazan; Kocaeli, Hasan; Yildirim, Nalan; Cebeci, Hakan; Erdogan, Cüneyt; Hakyemez, Bahattin

    2014-01-01

    Summary This study describes the peri-procedural and late complications and angiographic follow-up results of 32 patients with 34 complex aneurysms treated with flow diverter Silk stents in a single centre. In this retrospective study, 40 Silk stents (SS) were implanted in 34 complex intracranial aneurysms in 32 patients. In our series, 20 (58.8%) carotid-ophthalmic internal carotid artery (ICA), six (17.6%) cavernous ICA, two (5.9%) supraclinoid ICA, two (5.9%) petrosal ICA (the same patient- bilateral) and four (11.8%) posterior circulation aneurysms were treated. One of the posterior circulation lesions was a fenestrated-type aneurysm. Twenty wide-necked, saccular; eight neck remnant; four fusiform and two blister-like aneurysms were included in our series. SS were successfully implanted in all patients (100%). Misdeployment occurred in 17.6% of patients. In two of these patients adequate stent openness was achieved via Hyperglide balloon dilatation. Coil embolization in addition to SS placement was utilized in four aneurysms. One patient (3%) experienced transient morbidity due to a thromboembolic event and there was one mortality (3%) due to remote intraparenchymal haemorrhage. Complete occlusion of 27/33 (81.8 %) and 29/33 (87.9 %) aneurysms was achieved six and 12 months after the procedure, respectively. In-stent intimal hyperplasia was detected in 6.1 % patients. Flow-diverter Silk stent implantation is an effective method of treating complex aneurysms with acceptable mortality and morbidity rates. Complete occlusion is achieved in most of the complex aneurysms. PMID:25496683

  12. Importance of stent-graft design for aortic arch aneurysm repair

    Directory of Open Access Journals (Sweden)

    C Singh

    2017-02-01

    Full Text Available Aneurysm of the aorta is currently treated by open surgical repair or endovascular repair. However, when the aneurysm occurs in regions between the aortic arch and proximal descending aorta, it can be a complex pathology to treat due to its intricate geometry. When complex aortic aneurysms are treated with the conventional procedures, some of the patients present with significant post-operative complications and high mortality rate. Consequently, a clinically driven hybrid innovation known as the frozen elephant trunk procedure was introduced to treat complex aortic aneurysms. Although this procedure significantly reduces mortality rate and operating time, it is still associated with complications such as endoleaks, spinal cord ischemia, renal failure and stroke. Some of these complications are consequences of a mismatch in the biomechanical behaviour of the stent-graft device and the aorta. Research on complex aneurysm repair tended to focus more on the surgical procedure than the stent-graft design. Current stent-graft devices are suitable for straight vessels. However, when used to treat aortic aneurysm with complex geometry, these devices are ineffective in restoring the normal biological and biomechanical function of the aorta. A stent-graft device with mechanical properties that are comparable with the aorta and aortic arch could possibly lead to fewer post-operative complications, thus, better outcome for patients with complex aneurysm conditions. This review highlights the influence stent-graft design has on the biomechanical properties of the aorta which in turn can contribute to complications of complex aneurysm repair. Design attributes critical for minimising postoperative biomechanical mismatch are also discussed.

  13. [Giant congenital intrapericardial left atrial appendage aneurysm: about a case and review of the literature].

    Science.gov (United States)

    Zhari, Bouchra; Bellamlih, Habib; Boumdine, Hassan; Amil, Touriya; Bamous, Mehdi; En-Nouali, Hassan

    2016-01-01

    Left atrial appendage aneurysm is a very rare heart anomaly. It may be congenital or acquired, secondary to inflammatory or degenerative processes. Most cases are asymptomatic. The prevalence of these lesions in pediatric age has been very rarely reported. As it can cause potentially fatal arrhythmias or thrombus, surgery is required immediately after diagnosis. This study reports the case of a 14-year-old boy with rapidly progressive dyspnea, palpitations, sensation of repetitive dizziness and fainting, in whom congenital left atrial appendage aneurysm was detected. Diagnosis was based on coronary CTA data. The patient was successfully treated with surgical resection of the aneurysm.

  14. [The surgical treatment of an aneurysm of the celiac trunk and hepatic artery].

    Science.gov (United States)

    Rodríguez-Camarero, S J; Menéndez, A I; Rodero, J I; Alvarez, J L; Cermeño, B; Viana, M M

    1993-01-01

    We report a case of splenic aneurysms with double location, at the celiac trunks and at the common hepatic artery, in the same patient that was treated by a surgical procedure. We also review literature about the hepatic aneurysms at the celiac trunks, with special attention on the aspects of etiology, natural evolutions and different surgical procedures available. It is remarkable on this kind of pathology that special attention should be paid in order to avoid the simple ligature-exclusion of the aneurysm, it involves realizing an endoaneurysmorrhaphy followed by an aorto-hepatic by-pass.

  15. Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass

    Institute of Scientific and Technical Information of China (English)

    Stefano; Palmucci; Letizia; Antonella; Mauro; Pietro; Milone; Francesco; Di; Stefano; Antonino; Scolaro; Antonio; Di; Cataldo; Giovanni; Carlo; Ettorre

    2010-01-01

    Aneurysms and pseudoaneurysms of the superior mesenteric artery are potentially lethal and should be treated as urgently as possible.In a 52-year-old man with occasional epigastric pain,we accidentally discovered a superior mesenteric artery aneurysm that was ruptured with spontaneous tamponade in the uncinate process and in the head of the pancreas.The ruptured aneurysm had a heterogeneous appearance due to its thrombotic and hemorrhagic content,and it simulated a voluminous mass in the head and uncinate p...

  16. Mycotic aneurysm in a child with history of coarctation of the aorta repair

    Directory of Open Access Journals (Sweden)

    M Santiago Restrepo

    2014-01-01

    Full Text Available A mycotic aneurysm is a rare condition occasionally seen in patients with a history of prior cardiac or vascular surgery. Here we report the presentation of a mycotic aneurysm in a pediatric patient at the site of prior aortic coarctation repair. This patient′s initial presentation suggested rheumatologic or oncologic disease, and after diagnosis he continued to show evidence of splenic, renal and vascular injury distal to the mycotic aneurysm site while being treated with antibiotics. We discuss the diagnosis, treatment and management of this condition.

  17. [Endovascular treatment of a large aneurysm of the splenic artery using the Gianturco spirals].

    Science.gov (United States)

    Legkiĭ, A V; Maskin, S S; Ponomarev, E A; Ganichkin, S A; Mochaĭlo, Iu A

    2012-01-01

    A splenic artery aneurysm is a rarely encountered disease typically proceeding symptom-free and associated with a relatively high lethality rate, should a rupture occur. Currently, various types of endovascular treatment for this nosological entity are used widely. The article deals with a case of successful embolization of a large aneurysm of the splenic artery by means of the Gianturco spirals. The minimally invasive nature and high efficacy of this method make it possible to regard it as one of the therapeutic modalities for treating splenic-artery aneurysms.

  18. The management of very small/blister internal carotid artery aneurysms.

    Science.gov (United States)

    Le Feuvre, David E J; Taylor, A G

    2011-12-01

    Blood blister aneuryms are uncommon lesions that have a poor natural history. Because there is no clear aneurysmal sac to treat they remain challenging lesions to manage whether the approach is endovascular or surgical. Although the management of intracranial cerebral aneurysms has changed subsequent to the results published by the ISAT trial, there still exist groups of aneurysms which do not lend themselves to endovascular management. There are recent reports of successful endovascular management using flow diverting approaches but experience is limited and relying on flow change may be insufficient to prevent re-rupture. Surgery when possible offers the advantage of immediate vessel wall reconstruction.

  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......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  20. Idiopathic pulmonary artery aneurysm.

    Science.gov (United States)

    Kotwica, Tomasz; Szumarska, Joanna; Staniszewska-Marszalek, Edyta; Mazurek, Walentyna; Kosmala, Wojciech

    2009-05-01

    Pulmonary artery aneurysm (PAA) is an uncommon lesion, which may be associated with different etiologies including congenital cardiovascular diseases, systemic vasculitis, connective tissue diseases, infections, and trauma. Idiopathic PAA is sporadically diagnosed by exclusion of concomitant major pathology. We report a case of a 56-year-old female with an idiopathic pulmonary artery dilatation identified fortuitously by echocardiography and confirmed by contrast-enhanced computed tomography. Neither significant pulmonary valve dysfunction nor pulmonary hypertension and other cardiac abnormalities which might contribute to the PAA development were found. Here, we describe echocardiographic and computed tomography findings and review the literature on PAA management.

  1. A novel arterial pouch model of saccular aneurysm by concomitant elastase and collagenase digestion

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Background: An ideal aneurysm model of cerebral aneurysm is of great importance for studying the pathogenesis of the lesion and testing new techniques for diagnosis and treatment. Several models have been created in rabbits and are now widely used in experimental studies; however, every model has certain intrinsic limitations. Here we report the development of a novel saccular aneurysm model in rabbits using an arterial pouch that is subject to in vitro pre-digestion with combined elastase and collagenase. Methods: A segment of right common carotid artery (CCA) was dissected out and treated with elastase (60 U/ml, 20 min) followed by type I collagenase (1 mg/ml, 15 min) in vitro. The graft was anastomosed to an arterial arch built with the left CCA and the remaining right CCA, while the other end of the graft was ligated. The dimension and tissue structure of the pouch were analysed immediately, 2 or 8 weeks after operation. Findings: Ten terminal aneurysms were produced. The gross morphology of the aneurysm resembles the human cerebral terminal aneurysms. We have observed the following pathological changes:(1) growth of the aneurysm (mean diameter increased from (2.0±0.1) to (3.2±0.3) mm at 2 weeks, P<0.001, n=7~10); (2) thinning of the aneurysmal wall (the mean wall thickness decreased to 44% at 2 weeks), which was accompanied by significant losses of elastic fibres, collagen and the cellular component; and (3) spontaneous rupture (3 out of 9, one aneurysm ruptured 24 h after operation with the other two at 2 and 4 weeks respectively). Conclusion: This rabbit arterial pouch model mimics human cerebral aneurysms in relation to morphology and histology. In particular, this model exhibited an increased tendency of spontaneous rupture.

  2. A systematic review of pipeline embolization device for giant intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xianli Lv

    2017-01-01

    Full Text Available The experience with respect to the treatment of giant intracranial aneurysms with flow-diversion devices is limited. The aim of the present systematic review was to evaluate the effect of the pipeline embolization device (PED on giant intracranial aneurysms. Eligible related articles were identified by searching the PubMed, Web of Science, Springer, ScienceDirect, and OVID databases using “giant aneurysm” and “pipeline” as the search items. The date of the last search was November 20, 2015. This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In a total of 9 eligible studies with 200 patients and 215 aneurysms, 40 (18.6% giant (aneurysm diameter >25mm intracranial aneurysms treated with PED were analyzed. During a 6 to 34 month follow-up, complete occlusion was achieved in 23 (57.5% cases. Seven patients (17.5% developed intracranial hemorrhage, 5 developed ischemic attack (12.5%, and 13 (32.5% developed a mass effect after PED treatment. The complication rate was 77.8% in PED for giant vertebrobasilar artery aneurysms. The cumulative mortality rate for giant paraclinoid carotid artery and middle cerebral artery aneurysms was 13.3% and increased up to 50% for giant vertebrobasilar artery aneurysms. The complete obliteration rate of PED for giant intracranial aneurysms was approximately 60%. Mass effect is the most mechanism of complications. Complication and mortality rates associated with PED for giant vertebrobasilar artery aneurysms are still extremely high.

  3. Basilar skull fracture in a Thoroughbred colt: Radiography or computed tomography?

    Directory of Open Access Journals (Sweden)

    Chee Kin Lim

    2013-04-01

    Full Text Available A two-year-old Thoroughbred colt was presented to the Equine Clinic, Onderstepoort Veterinary Academic Hospital for head trauma after rearing and falling backwards, hitting his head on the ground. Following medical therapy for acute onset neurological impairment secondary to a suspected basilar skull fracture, the horse was anaesthetised and computed tomography of the skull was performed. A diagnosis of a comminuted basilar skull fracture was made and skull radiographs were taken for comparison. The horse was subsequently euthanased owing to the poor prognosis; necropsy findings were compatible with imaging findings. The value and limitation of computed tomography versus radiography for the diagnosis of basilar skull fracture are discussed in this report. Introduction

  4. Basilar skull fracture in a Thoroughbred colt: Radiography or computed tomography?

    Directory of Open Access Journals (Sweden)

    Chee Kin Lim

    2013-02-01

    Full Text Available A two-year-old Thoroughbred colt was presented to the Equine Clinic, Onderstepoort Veterinary Academic Hospital for head trauma after rearing and falling backwards, hitting his head on the ground. Following medical therapy for acute onset neurological impairment secondary to a suspected basilar skull fracture, the horse was anaesthetised and computed tomography of the skull was performed. A diagnosis of a comminuted basilar skull fracture was made and skull radiographs were taken for comparison. The horse was subsequently euthanased owing to the poor prognosis; necropsy findings were compatible with imaging findings. The value and limitation of computed tomography versus radiography for the diagnosis of basilar skull fracture are discussed in this report.

  5. Characterization of CGRP(1) receptors in the guinea pig basilar artery

    DEFF Research Database (Denmark)

    Jansen-Olesen, I; Kaarill, L; Edvinsson, L

    2001-01-01

    The purpose of the present study was to characterise receptors mediating calcitonin gene-related peptide (CGRP)-induced relaxation of guinea pig basilar artery. This was done by investigating vasomotor responses in vitro and performing autoradiographic binding studies. We also intended to study...... the importance of an intact endothelium. Agonist studies showed that peptides of the CGRP family induced relaxation of the guinea pig basilar artery with the following order of potency: human beta-CGRP=human alpha-CGRP>adrenomedullin=[acetamidomethyl-Cys(2,7)]alpha-human CGRP ([Cys(ACM)(2,7)]CGRP...... in the absence of human CGRP-(8-37). The study shows the presence of a relaxant CGRP(1) receptor on the smooth muscle cells of guinea pig basilar artery. Various endothelial factors did not influence relaxant responses....

  6. 'Top of the basilar' syndrome: Clinico-radiological evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Sato, M.; Tanaka, S.; Kohama, A.

    1987-07-01

    Sixteen patients having infarction caused by circulatory disturbance at the top of the basilar artery, that is to say, the 'top of the basilar' syndrome, were studied, the diagnosis having been made by computerized tomography. Infarcts were widely distributed in each patient between the thalamus, midbrain, pons, cerebellum, and occipital lobe. Both thalami were involved in 7 cases. When the thalamus was involved bilaterally, the low density areas were symmetrical in size and localization. Angiography revealed that stenosis or occlusion by within a circle 2 cm in diameter surrounding the five-forked junction at the top of the basilar artery in 84.6%. Recanalization of the occluded artery occurred in 61.5%, suggesting that embolism played an important role in appearance of this syndrome.

  7. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

    NARCIS (Netherlands)

    Georgiadis, Georgiadis; van Herwaarden, Joost A.; Antoniou, George A.; Giannoukas, Athanasios D.; Lazarides, Miltos K.; Moll, Frans L.

    2016-01-01

    The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line man

  8. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  9. Subject-specific modeling of intracranial aneurysms

    Science.gov (United States)

    Cebral, Juan R.; Hernandez, Monica; Frangi, Alejandro; Putman, Christopher; Pergolizzi, Richard; Burgess, James

    2004-04-01

    Characterization of the blood flow patterns in cerebral aneurysms is important to explore possible correlations between the hemodynamics conditions and the morphology, location, type and risk of rupture of intracranial aneurysms. For this purpose, realistic patient-specific models are constructed from computed tomography angiography and 3D rotational angiography image data. Visualizations of the distribution of hemodynamics forces on the aneurysm walls as well as the intra-aneurysmal flow patterns are presented for a number of cerebral aneurysms of different sizes, types and locations. The numerical models indicate that there are different classes of intra-aneurysmal flow patterns, that may carry different risks of rupture.

  10. Endovascular repair of a paraanastomotic aneurysm with inverted limb infrarenal bifurcated graft.

    Science.gov (United States)

    Stringari, Carlo; Perkmann, Reinhold; Zaraca, Francesco

    2014-02-01

    A typical complication after conventional aortic prosthetic reconstruction is paraanastomotic aneurysm formation. Endovascular exclusion of paraanastomotic aneurysms has been shown to be a viable alternative to open surgical repair and to greatly reduce morbidity and mortality rates. We present a case report of asymptomatic proximal anastomotic pseudoaneurysm, measuring 4.5 cm in diameter, that was successfully treated by endovascular repair with a custom-made inverted limb infrarenal bifurcated graft.

  11. Endovascular repair of descending thoracic aortic aneurysm via midsternotomy and without extracorporeal circulation.

    Science.gov (United States)

    Abad, C; Garzon, G; Ponce, G; Reyes, R; Rodriguez, D

    2003-12-01

    A 68-year-old man with peripheral vascular disease and associated risk factors, was diagnosed by CT-scan and aortography with an atherosclerotic descending thoracic aortic aneurysm. The patient was treated by successful endovascular grafting of the aneurysm using a midsternotomy incision and the insertion of a thoracic stent-graft through a T-Dacron tube sutured in the ascending aorta, without the aid of cardiopulmonary bypass.

  12. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Golzarian, Jafar [University of Iowa, University of Iowa Heath Care, IA (United States); Valenti, David [McGill University, Royal Victoria Hospital, McGill University Health Centre, Montreal (Canada)

    2006-12-15

    Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak. (orig.)

  13. Critical appraisal of the international subarachnoid aneurysm trial (ISAT

    Directory of Open Access Journals (Sweden)

    Sade B

    2004-01-01

    Full Text Available The results of the International Subarachnoid Aneurysm Trial (ISAT drew attention from both scientific and lay press, impacting the management of aneurysm patients significantly. In this review, the ISAT report was analyzed critically and the available literature was scrutinized stratifying the common criticisms as to the weak aspects of this study. The aim of ISAT was to compare the safety and efficacy of endovascular coiling with neurosurgical clipping for aneurysms, which were suitable for both treatments. The results showed a 22.5% relative and 6.9% absolute risk reduction at one year in the disability outcome of patients who were treated with coiling. However, long-term risk of re-bleeding from the treated aneurysms and the risk of repeat procedures was higher in this group also. Lack of angiographic data following the initial treatment and long-term follow-up represents one of the main flaws of this study. The outcome assessment scale, biases regarding patient selection and center participation criteria were further issues of criticism. The results of ISAT are not sufficient to provide a definitive answer as to the superiority of endovascular treatment over microsurgery, although coiling appears to produce less peri-procedural morbidity in a selected group of patients. An optimum outcome assessment should include a universally accepted scale and a detailed long-term angiographic outcome.

  14. Pharmacological and molecular comparison of K(ATP) channels in rat basilar and middle cerebral arteries

    DEFF Research Database (Denmark)

    Ploug, Kenneth Beri; Edvinsson, Lars; Olesen, Jes;

    2006-01-01

    ATP-sensitive potassium (K(ATP)) channels play an important role in the regulation of cerebral vascular tone. In vitro studies using synthetic K(ATP) channel openers suggest that the pharmacological profiles differ between rat basilar arteries and rat middle cerebral arteries. To address this issue....... Densitometric measurements of the Western blot signals further showed higher expression levels of Kir6.1 and SUR2B proteins in rat middle cerebral arteries than was found in rat basilar arteries. In conclusion, our in vitro pharmacological studies showed no evidence for functional endothelial K(ATP) channels...

  15. Acute stenting and thromboaspiration in basilar artery occlusions due to embolism from the dominating vertebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Nedeltchev, K.; Remonda, L.; Brekenfeld, C.; Ozdoba, C.; Schroth, G. [Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 4, 3010, Bern (Switzerland); Do, D.D. [Institute of Angiology, University of Bern, Inselspital, Bern (Switzerland); Arnold, M.; Mattle, H.P. [Department of Neurology, University of Bern, Inselspital, Bern (Switzerland)

    2004-08-01

    Intra-arterial thrombolysis (IAT) is the only treatment that has demonstrated benefit in patients with acute basilar artery occlusions (ABAO). IAT may be difficult to perform when access to the occluded basilar artery (BA) is prevented by pathology of the vertebral arteries (VA). We report on two patients with ABAO due to embolism from the dominating VA. Catheter navigation through the occluded VA and thromboaspiration enabled access to the BA. Thromboaspiration alone or in addition to IAT resulted in a complete recanalization of the BA and a favorable clinical outcome. A stent was deployed at the site of the stenosis in the VA either prior to or immediately after BA recanalization. (orig.)

  16. Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.

    Science.gov (United States)

    Reig, Adam S; Simon, Scott; Mericle, Robert A

    2009-11-01

    Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

  17. Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Moron, Felix; Sun, Hai; Oppenlander, Mark E; Kalani, M Yashar S; Mulholland, Celene B; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

    2016-09-01

    OBJECTIVE To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping ("cotton-clipping" technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton ("cotton-augmentation" technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. METHODS The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. RESULTS The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24-72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10-126 months

  18. Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry; Thrombolyse der A. basilaris: Ergebnisse im Saarland ueber einen Zeitraum von 5 Jahren

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Struffert, T.; Roth, C.; Papanagiotou, P.; Scheuermann, J.; Voges, M.; Reith, W. [Universitaetsklinikum des Saarlandes Homburg (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie

    2005-05-01

    Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome. (orig.) [German] Der akute Verschluss der A. basilaris fuehrt unbehandelt in der Regel rasch zum Tod. Aufgrund des zumeist fatalen Ausgangs unbehandelter Basilaristhrombosen und der relativ guten Prognose bei Behandlung mit lokaler intraarterieller Thrombolyse wird diese Therapie als das Mittel der Wahl bei akuter Basilaristhrombose angesehen. Anhand des Saarlaendischen Schlaganfallregisters wurden 47 Patienten mit einer nachgewiesenen Basilaristhrombose ueber einen Zeitraum von 5 Jahren in diese Studie eingeschlossen. Es konnte nachgewiesen werden, dass eine kurze Zeit bis zum Therapiebeginn, ein gutes Income sowie eine erfolgreiche Rekanalisation mit einem guten klinischen Outcome korreliert waren. Komplikationen traten ausnahmslos bei einer Lysetherapie mit rt-PA auf. Die intraarterielle Behandlung von Basilarisverschluessen mit Urokinase oder rt-PA sollte an spezialisierten, interventionellangiographisch taetigen Zentren vorgenommen werden. Bei fluktuierendem Beginn kann das Zeitfenster bis zu 12 h betragen, nach einer Komadauer von mehr als 4 h ist in der Regel kein guenstiges Outcome zu erwarten. (orig.)

  19. Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: A single-centre experience in a series of 15 patients

    Directory of Open Access Journals (Sweden)

    Qi Wu

    2013-01-01

    Full Text Available Background: Aneurysms located at distal posterior inferior cerebellar artery (PICA are rare. These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms. Aims: To investigate the clinical and radiologic efficacy of parent artery occlusion (PAO with embolic agent Onyx in the treatment of distal PICA aneurysm. Materials and Methods: Case records of 15 consecutive patients with 15 ruptured distal PICA aneurysms treated with Onyx embolization were reviewed retrospectively. The follow-up ranged between 6 and 52 months. Cerebral angiography or cerebra computed tomography-angiogram (CTA was performed for follow-up radiological study. Two aneurysms had origin from tonsillomedullary segment, nine from telovelotonsillar segments, and four from cortical segments. All patients were treated with Onyx to occlude aneurysm and proximal portion of vessel in front of aneurysm via endovascular approach. Results: Aneurysm was occluded completely in every patient. One patient died because of intra-procedure haemorrhage. Fourteen patients had good recovery and the last follow-up Glasgow outcome scale was 5. Head CT scan was performed in every survived patient before discharge. CT in 3 patients revealed cerebellar infarctions but without any neurological deficits. None of the 14 patients had rebleeding or fresh neurologic deficits during the follow-up period. Aneurysmal recanalization had not been observed in any of the survived patients. Conclusions: Onyx occlusion of proximal parent artery and aneurysm in the treatment of distal PICA aneurysm is safe and effective according to this study. Morphology and location of aneurysm are important to decide the therapeutic strategy.

  20. Comparative Study in the Diagnosis of Intracranial Aneurysms with 64 Slice CTA-and 3D DSA%64层CTA-MIP、CTA-VR与3D-DSA对颅内动脉瘤诊断价值的对比研究

    Institute of Scientific and Technical Information of China (English)

    刘善平

    2012-01-01

    目的 对比评价64层螺旋CT最大密度投影(CTA-MIP),CTA容积再现(CTA-VR)与三维数字血管造影(3D-DSA)对颅内动脉瘤(CA)的诊断价值.资料与方法 回顾性分析32例经手术及DSA确诊的CA 64层CT血管成像资料,并与DSA进行对照.结果 32例共40个动脉瘤,CTA-MIP发现35个动脉瘤,CTA-VR发现37个动脉瘤,3D-DSA发现39个动脉瘤.40个动脉瘤中11个位于后交通动脉,16个位于大脑中动脉,4个位于基底动脉,1个位于椎动脉,2个位于大脑前动脉,3个位于大脑后动脉,3个位于颈内动脉.3 D-DSA与CTA比较,差异无统计学意义.结论 在CA影像学诊断上,CTA-MIP、CTA-VR和3D-DSA各有优势,CTA可作为外科治疗或介入治疗的筛选方法.%Objective To evaluate the role of 64 slice computed tomography angiography maximum intensity projection (CTA,MIP) , computed tomography angiography volume rendering (CTA,VR) and 3 dimensional digital subtraction angiogtaphy(3D-DSA) ) in the diagnosis of intracranial aneurysms. Materials and Methods The CT and DSA imaging findings of 32 patients with aneurysms were retrospectively analyzed and compared. Results 40 aneurysms in 32 patients were found by DSA and/or operation. 35 aneurysms were found by CTA MIP. 37 aneurysms were found by CTA VR. 39 aneurysms were found by DSA. 11 aneurysms were at posterior communicating artery, 16 aneurysms at middle cerebral artery, 4 aneurysms at basilar artery, 1 aneurysms at vertebary artery, 2 aneurysms at anterior cerebral artery, 3 aneurysms at posterior cerebral artery, 3 aneurysms at internal carotid artery. There was no significant difference in detecting aneurysms between CTA and 3D DSA. Conclusion CTA MIP, CTA VR and 3D-DSA examination have their own advantage in diagnosis of intracranial aneurysms. CTA can be used as the method in screening intracranial aneurysms for surgery and interventional therapy.

  1. Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms

    Science.gov (United States)

    Gupta, Mihir; Cheung, Vincent J; Abraham, Peter; Wali, Arvin R; Gabel, Brandon C; Almansouri, Abdulrahman; Pannell, J. Scott; Khalessi, Alexander A

    2017-01-01

    Objective: Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries. Methods: We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology. Results: Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases. Conclusion: Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off

  2. Clinical presentation of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cianfoni, Alessandro [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Pravatà, Emanuele, E-mail: emanuele.pravata@gmail.com [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); De Blasi, Roberto [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Tschuor, Costa Silvia [Dipartimento di Radiologia, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Bonaldi, Giuseppe [U.O. Neuroradiologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24128 Bergamo (Italy)

    2013-10-01

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.

  3. A failure of matrix metalloproteinase inhibition in the prevention of rat intracranial aneurysm formation

    Energy Technology Data Exchange (ETDEWEB)

    Kaufmann, T.J.; Kallmes, D.F. [Mayo Clinic and Foundation, Department of Radiology, Rochester, MN (United States); Marx, W.F. [Asheville Radiology Associates, Asheville, NC (United States)

    2006-03-15

    We tested the hypothesis that nonspecific matrix metalloproteinase (MMP) inhibition with doxycycline would decrease the incidence of intracranial aneurysm formation in a rat aneurysm model. We performed common carotid artery ligation on 96 Long-Evans rats. A treatment group of 48 animals was chosen at random to receive oral doxycycline (3 mg/kg) in addition to standard rat chow, and the control group of 48 animals received standard rat chow only. The major circle of Willis arteries was dissected at 1 year following carotid ligation, and the proportions of animals with aneurysms were compared between groups using Fisher's exact test. Four animals given oral doxycycline and ten control animals expired before 1 year. Of the examined animals, eight saccular intracranial aneurysms were found in 8 of 45 animals which had received doxycycline (17.8%) and seven saccular intracranial aneurysms were found in 7 of 37 control animals (18.9%). There was no significant difference in aneurysm formation between the doxycycline-treated and control groups (P=0.894). Nonspecific MMP inhibition with doxycycline is not effective in preventing intracranial aneurysm formation in a rat model. (orig.)

  4. Mycotic aneurysm in a turtle hunter: brief review and a case report

    Directory of Open Access Journals (Sweden)

    Harsha Moole

    2015-06-01

    Full Text Available Salmonella-associated mycotic aneurysm is a rare, but dreaded, complication of salmonellosis. Immunocompromised and elderly populations are more susceptible to develop this extra-intestinal complication. Salmonella is spread via fecal–oral and vehicle-borne routes. Reptiles, especially small pet turtles, have been linked with an increased risk of Salmonella infection. Diagnosis of mycotic aneurysm is a challenge due to atypical presentations. Recently, widespread use of CT scan imaging to evaluate for unexplained abdominal pain and sepsis has led to early identification of mycotic aneurysms. Antibiotic therapy and surgical intervention are the cornerstones of management. Open surgery has been the gold standard of treatment but is associated with increased morbidity and mortality. A relatively new alternative to open surgery is endovascular aneurysm repair (EVAR. It is comparatively less invasive and is associated with reduced early morbidity and mortality in the setting of mycotic aneurysm. However, there is a risk of late infection. Here, we present a patient with Salmonella mycotic aneurysm initially treated conservatively with antibiotic therapy who later underwent successful interval EVAR with no complications to date. Also included is a brief review of Salmonella-associated mycotic aneurysms.

  5. Endovascular treatment of recurrent intracranial aneurysms following previous microsurgical clipping with the Pipeline Embolization Device.

    Science.gov (United States)

    Ding, Dale; Starke, Robert M; Evans, Avery J; Jensen, Mary E; Liu, Kenneth C

    2014-07-01

    The treatment of intracranial aneurysms with microsurgical clipping is associated with a very low rate of recurrence. However, in cases of aneurysm recurrence after previous clipping, microsurgical dissection due to adhesions and fibrosis may be challenging, and it may be difficult to safely occlude the recurrent lesion without the risk of significant morbidity. Flow-diverting stents have drastically changed the landscape of endovascular neurosurgery. We present two patients with large, recurrent supraclinoid internal carotid artery (ICA) aneurysms which were previously clipped 17 and 23 years ago at outside institutions. Both recurrent lesions were treated with the Pipeline Embolization Device (PED; ev3 Endovascular, Irvine, CA, USA) without radiographic or clinical complications. In the first patient, the 15 mm aneurysm significantly decreased in size at 6 month angiographic follow-up. The 21 mm aneurysm in the second patient was completely occluded 7 months following PED treatment. The moderate degree of in-stent stenosis present on initial follow-up imaging resolved on angiography 11 months post-treatment. The management of recurrent aneurysms after clipping is sparsely reported in the literature due to its infrequent occurrence. In carefully selected cases, flow-diverting stents may be used for complex aneurysms of the distal ICA, even for those which have recurred following microsurgical clipping.

  6. Correlation between Hemodynamics and Treatment Outcome of Intracranial Aneurysms after Intervention with Flow Diverters

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert; Davies, Jason; Siddiqui, Adnan; Meng, Hui

    2015-11-01

    Endovascular intervention by Flow Diverter (FD) - a densely woven stent - occludes an aneurysm by inducing thrombosis in the aneurysm sac and reconstructing the vessel. Hemodynamics plays a vital role in the thrombotic occlusion of aneurysms and eventual treatment outcome. CFD analysis of pre- and post-treatment aneurysms not only provides insight of flow modifications by FD, but also allows investigation of interventional strategies and prediction of their outcome. In this study 80 patient-specific aneurysms treated with FDs were retrospectively studied to evaluate the effect of intervention. Out of these cases, 16 required retreatment and thus are considered as having unfavorable outcome. Clinical FD deployment in these cases was simulated using an efficient virtual stenting workflow. CFD analysis was carried out on both pre- and post-treatment cases, and changes in hemodynamic parameters were calculated. Support vector machine algorithm was used to correlate the hemodynamic changes with outcome. Results show that cases having higher flow reduction into the aneurysmal sac have a better likelihood of occlusion. This suggests that changes in hemodynamics can be potentially used to predict the outcome of different clinical intervention strategies in aneurysms. This work was supported by the National Institutes of Health (R01 NS091075).

  7. Microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches

    Directory of Open Access Journals (Sweden)

    Hong-guang WANG

    2016-08-01

    Full Text Available Objective To investigate surgical strategies, clinical effects and complications of microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches.  Methods Review clinical data of 18 cases with anterior circulation mirror aneurysms who underwent one-stage clipping via bilateral frontolateral approaches from July 2010 to July 2015 admitted to Department of Neurosurgery in Tianjin Huanhu Hospital. The operative efficacy was evaluated according to postoperative Glasgow Outcome Scale (GOS.  Results The 36 aneurysms in 18 patients were successfully clipped via bilateral frontolateral approaches at one-stage, including 18 posterior communicating artery (PCoA mirror aneurysms in 9 cases and 18 middle cerebral artery (MCA mirror aneurysms in 9 cases. GOS score of 5 was discovered in 16 cases, and 4 was discovered in 2 cases after operation. One case underwent ventriculoperitoneal shunting (VPS due to communicating hydrocephalus, one case got postoperative pulmonary infection and no death occurred. Intracranial CTA at 6 months postoperatively showed aneurysms of 18 patients were clipped completely, the parent artery blood flow was smooth, and no recurrence was found.  Conclusions Microsurgical one-stage clipping via bilateral frontolateral approaches for treating intracranial mirror aneurysms is a sugrical method with small incision, fitting surgical field, high safety, satisfactory effect and good prognosis, which is a new minimally invasive neurosurgical technique. DOI: 10.3969/j.issn.1672-6731.2016.08.012

  8. Transluminal Attenuation Gradient for Thrombotic Risk Assessment in Kawasaki Disease Patients with Coronary Artery Aneurysms

    Science.gov (United States)

    Grande Gutierrez, Noelia; Kahn, Andrew; Burns, Jane; Marsden, Alison

    2014-11-01

    Kawasaki Disease (KD) can result in coronary aneurysms in up to 25% of patients if not treated early putting patients at risk of thrombus formation, myocardial infarction and sudden death. Clinical guidelines for administering anti-coagulation therapy currently rely on anatomy alone. Previous studies including patient specific modeling and computer simulations in KD patients have suggested that hemodynamic data can predict regions susceptible to thrombus formation. In particular, high Particle Residence Time gradient (PRTg) regions have shown to correlate with regions of thrombus formation. Transluminal Attenuation Gradient (TAG) is determined from the change in radiological attenuation per vessel length. TAG has been used for characterizing coronary artery stenoses, however this approach has not yet been used in aneurysmal vessels. The aim of this study is to analyze the correlation between TAG and PRTg in KD patients with aneurysms and evaluate the use of TAG as an index to quantify thrombotic risk. Patient specific anatomic models for fluids simulations were constructed from CT angiographic image data from 3 KD aneurysm patients and one normal control. TAG values for the aneurysm patients were markedly lower than for the non-aneurysmal patient (mean -18.38 vs. -2). In addition, TAG values were compared to PRTg obtained for each patient. Thrombotic risk stratification for KD aneurysms may be improved by incorporating TAG and should be evaluated in future prospective studies.

  9. [False aneurysm of the left ventricle and coronary aneurysms in Behçet disease].

    Science.gov (United States)

    Rolland, J M; Bical, O; Laradi, A; Robinault, J; Benzidia, R; Vanetti, A; Herreman, G

    1993-09-01

    A false left ventricular aneurysm and coronary artery aneurysm were discovered in a 29 year old patient with Behçet's syndrome. The operation under cardiopulmonary bypass consisted of closing the neck of the false aneurysm by an endo-aneurysmal approach with a Gore-Tex patch. The coronary artery aneurysms were respected. There were no postoperative complications. Cardiac involvement is rare in Behçet's syndrome (6%). The originality of this case is the association of two aneurysmal pathologies: the coronary and ventricular aneurysms due to the angiitis and the myocardial fragility induced by ischaemia.

  10. Postoperative recovery from posterior communicating aneurysm complicated by oculomotor palsy

    Institute of Scientific and Technical Information of China (English)

    YANG Ming-qi; WANG Shuo; ZHAO Yuan-li; ZHANG Dong; ZHAO Ji-zong

    2008-01-01

    Background Oculomotor palsy is a common complication in patients with posterior communicating aneurysm.This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneurysm complicated with oculomotor palsy and to analyze the factors influencing length of recovery.Methods From 2000 to 2006,148 patients with posterior communicating aneurysm were treated at our hospital,with 74 of them having concurrent unilateral oculomotor palsy.All of the patients underwent craniotomy after the diagnosis by means of whole-brain digital subtraction angiography (DSA).The patients were divided into two groups for observation of postoperative recovery during the follow-up period.Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve.Results Of the 40 patients in group A.20 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days.Fourteen patients underwent surgery within 14-30 days.of whom 12 completely recovered within 30-90 days and 2 cases recovered incompletely.The remaining six patients underwent surgery after more than 30 days:of these.four patients recovered completely and two recovered incompletely.Of the 34 cases in group B,15 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days.Sixteen patients underwent surgery in 14-30 days.of whom 14 completely recovered in 30-90 days and 2 recovered incompletely.The remaining three patients underwent surgery after more than 30 days,of whom two patients recovered completely and one recovered incompletely.Conclusions Early diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve.No correlation was found,however,between decompression of the

  11. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    Science.gov (United States)

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  12. Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA)

    Science.gov (United States)

    Galiñanes, Edgar Luis; Krajcer, Zvonimir

    2015-01-01

    For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms. PMID:27069944

  13. Osteogenesis imperfecta in childhood: MR imaging of basilar impression

    Energy Technology Data Exchange (ETDEWEB)

    Janus, G.J.M. E-mail: janus@knmg.nl; Engelbert, R.H.H.; Beek, E.; Gooskens, R.H.J.M.; Pruijs, J.E.H

    2003-07-01

    Objective: To determine on radiographs the presence of Basilar Impression (BI) in children with Osteogenesis Imperfecta (OI). To confirm this sign and altered geometrical relationships of the craniocervical junction in course of time with magnetic resonance imaging (MRI). Methods and patients: In a cohort study of 130 patients with OI (OI type I: 85; OI type III: 21; OI type IV: 24) lateral radiographs of the skull and cervical spine were made in a standardised way. MRI scans were performed when BI was suspected based upon protrusion of the odontoid above Chamberlain's line. Intracranial abnormalities as well as the basal angle were described. Neurological examination was performed in patients with conclusive BI at MRI-scan. Results and discussion: In eight patients BI could be confirmed by MRI-scan. None of the children had or developed in time neurological symptoms or signs. Follow up of BI by MRI scans was done in seven patients (mean: 5 years; range: 2-6 years). No alteration of intracranial findings were seen at subsequent investigation, although in one child Chamberlain's line increased from 8 (first MRI) to 15 mm (last MRI). BI can be diagnosed by radiographs but in the extreme osteoporotic bone and altered anatomy of the craniocervical junction of children with OI MRI is preferable. As intracranial pathology can be demonstrated by MRI, also a relation can be laid to possible neurological symptoms and signs at clinical examination. Conclusion: In our cohort study no alteration of the intracranial contents was seen at subsequent MRI scans. Although anatomic deformations exist in BI, no neurological symptoms or signs were present in our study and no operative reconstruction had to be performed. Periodical MRI-scan has not been of influence on the clinical decision making process. At the moment we perform a MRI-scan if BI is suspected at lateral skull radiographs. The MRI images serve as reference findings to anticipate on possible future symptoms and

  14. Intracranial aneurysm associated with relapsing polychondritis

    Energy Technology Data Exchange (ETDEWEB)

    Coumbaras, M.; Boulin, A.; Pierot, L. [Dept. of Neuroradiology, Hopital Foch, Suresnes (France); Piette, A.M.; Bletry, O. [Dept. of Medicine, Hopital Foch, Suresnes (France); Graveleau, P. [Dept. of Neurology, Hopital Foch, Suresnes (France)

    2001-07-01

    We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. (orig.)

  15. A histopathologic study of retinal arterial aneurysms.

    Science.gov (United States)

    Fichte, C; Streeten, B W; Friedman, A H

    1978-04-01

    An isolated retinal arterial aneurysm was found postmortem in the eye of a 75-year-old hypertensive woman, and multiple aneurysms were in the enucleated eye of a 68-year-old hypertensive man with neovascular glaucoma. The aneurysmal sites showed thickening of the vessel walls with hyaline, fibrin, and foamy macrophages. Fresh or organized thrombus partially filled the aneurysmal lumina. Trypsin digestion preparations in Case 2 showed a progressive severity of aneurysmal changes from the simplest "cuff" type to the hemorrhagic "b;pwout" aneurysms with a linear split in the vessel wall. Atheroma was present in the larger arterial branches and fat was in most of the aneurysmal walls. These findings suggested that damage to the arterial wall by cholesterol or other emboli, or by occlusive disease, may predispose especially hypertensive patients to arterial aneurysm formation.

  16. Abdominal aortic aneurysm repair - open - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000240.htm Abdominal aortic aneurysm repair - open - discharge To use the sharing features ... References Orandi BJ, Black JH. Open repair of abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  17. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal

    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....... The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 5-year...... methods for measuring the degree of wall calcification must be developed and validated....

  18. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture.......Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  19. Analysis of an impulse response measured at the basilar membrane of the chinchilla (L)

    NARCIS (Netherlands)

    Wit, Hero P.; Bell, Andrew

    2015-01-01

    In a recent paper [J. Acoust. Soc. Am. 133, 2224-2239 (2013)], Shera and Cooper report on the impulse response of the basilar membrane (BM) of a chinchilla, a waveform which shows repetitive bursts. They explain the bursts in terms of repeated coherent reflection at BM discontinuities and partial re

  20. Pharmacological and molecular comparison of K(ATP) channels in rat basilar and middle cerebral arteries

    DEFF Research Database (Denmark)

    Ploug, Kenneth Beri; Edvinsson, Lars; Olesen, Jes;

    2006-01-01

    ATP-sensitive potassium (K(ATP)) channels play an important role in the regulation of cerebral vascular tone. In vitro studies using synthetic K(ATP) channel openers suggest that the pharmacological profiles differ between rat basilar arteries and rat middle cerebral arteries. To address this issue...

  1. Basilar impression associated with impacted cisterna magna, spastic paraparesis and distress of balance: case report

    Directory of Open Access Journals (Sweden)

    Gonçalves da Silva José Alberto

    2006-01-01

    Full Text Available We report on a 48 years-old man with basilar impression without syringohydromyelia, in which the cisterna magna was impacted by the cerebellar tonsils. Six months after posterior fossa decompression there was the disappearance of nuchal rigidity, vertigo, spastic paraparesis and improvement of balance. Nevertheless hyperreflexia and diminished pallesthesia of the lower limbs persisted.

  2. Cross-sectional imaging for diagnosis and clinical outcome prediction of acute basilar artery thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Mortimer, A.M., E-mail: alex_mortimer@hotmail.co [Severn School of Radiology, Bristol (United Kingdom); Department of Radiology, Great Western Hospital, Swindon (United Kingdom); Saunders, T.; Cook, J.-L. [Department of Radiology, Great Western Hospital, Swindon (United Kingdom)

    2011-06-15

    Basilar artery occlusion is a potentially fatal condition and imaging findings can be subtle. Prompt diagnosis is vital, as recognition may lead to therapeutic recanalization that may improve functional outcome and survival. Furthermore, cross-sectional imaging signs may help predict eventual outcome and, therefore, guide which patients should be subjected to aggressive treatment. Computed tomography (CT) signs include a hyperdense basilar artery that has a high specificity, accuracy, positive and negative predictive value. Evidence regarding the prognostic significance of the hyperdense basilar artery sign is conflicting. Early magnetic resonance imaging (MRI) features include loss of flow void, seen as increased signal intensity within the basilar artery on T2-weigted images and identification of acute thrombus, seen as intermediate signal on T1-weighted images. MRI sequences are more sensitive for early detection of acute ischaemia or infarction, ideally with diffusion-weighted imaging (DWI). Both CT and MR angiography are sensitive for detection of acute thrombus, seen as a filling defect or occlusion. These are the non-invasive imaging techniques of choice to confirm diagnosis, with perhaps the speed and accessibility of CT angiography resulting in this technique being valuable in the acute setting. Several new scoring systems based on arterial segmentation rather than global volume assessment using CT angiography source images and DWI have shown early promise in the prediction of eventual clinical outcome in order to isolate those patients who may benefit from therapeutic recanalization.

  3. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

    NARCIS (Netherlands)

    Conforto, Adriana B.; De Freitas, Gabriel R.; Schonewille, Wouter J.; Kappelle, L. Jaap; Algra, Ale

    2015-01-01

    Background The presence of prodromal transient ischemic attacks (TIAs) has been associated with a favorable outcome in anterior circulation stroke. We aimed to determine the association between prodromal TIAs or minor stroke and outcomes at 1 month, in the Basilar Artery International Cooperation St

  4. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

    NARCIS (Netherlands)

    Conforto, A.B.; Freitas, G.R. de; Schonewille, W.J.; Kappelle, L.J.; Algra, A.; Leeuw, F.E. de

    2015-01-01

    BACKGROUND: The presence of prodromal transient ischemic attacks (TIAs) has been associated with a favorable outcome in anterior circulation stroke. We aimed to determine the association between prodromal TIAs or minor stroke and outcomes at 1 month, in the Basilar Artery International Cooperation S

  5. Different Imaging Strategies in Patients with Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis

    NARCIS (Netherlands)

    S.E. Beyer (Sebastian E.); M.G.M. Hunink (Myriam); F. Schöberl (Florian); L. von Baumgarten; S.E. Petersen (Steffen); C. Kubisch (Christian); H. Janssen (Hendrik); B. Ertl-Wagner (Birgit); M.F. Reiser (Maximilian F.); W.H. Sommer (Wieland H.)

    2015-01-01

    textabstractBackground and Purpose-This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. Methods-A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tom

  6. Obstrução do tronco basilar: registro de três casos

    Directory of Open Access Journals (Sweden)

    Adolfo Pou-Serradel

    1984-06-01

    Full Text Available Registro de três casos de obliteração do tronco basilar, todos êles em uma idade em que a arteriosclerose é infrequente. O diagnóstico foi confirmado angiograficamente. A evolução foi diferente em cada um deles.

  7. EFFECT OF ACUPUNCTURE ON BLOOD FLOW OF VERTEBRAL AND BASILAR ARTERIES IN STROKE PATIENTS

    Institute of Scientific and Technical Information of China (English)

    吕建明; 王伟志

    2004-01-01

    Objective: To observe the short-term effect and long-term effect of acupuncture on blood flow of vertebral and basilar arteries in stroke patients.Methods: A total of 58 stroke patients (34 males and 24 females) were agreed to participate in this study, and changes of blood flow of the vertebral and basilar arteries were detected after one week's and 45 days' continuous acupuncture treatment by using a Doppler's ultrasonic diagnosis apparatus.Bilateral Fengchi (GB 20), Wangu (GB 12), Tianzhu (BL 10), etc.were punctured and stimulated with small amplitude, high frequency and twirling-reinforcing method for 3 min.The treatment was conducted once daily.Results: Following one week's and 45 days' acupuncture treatment, diastolic velocity (DV), systolic velocity (SV) and mean velocity (MV) of the basilar artery increased significantly in comparison with pre-treatment (P0.05).Results indicated that acupuncture treatment could effectively improve blood supply of the basilar artery and regulate the uneven blood flow of the bilateral vertebral arteries.Conclusion: Acupuncture treatment can raise blood flow of the brain in stroke patients.

  8. CLINICAL APPLICATION IF STENT -ASSISTED MECHANICALLY -DETECHABLE COIL EMBOLIXATION IN TREATING INTRACRANIAL WILD -NECKED ANEURYSMS%支架辅助机械解脱弹簧圈栓塞治疗颅内宽颈动脉瘤的临床应用

    Institute of Scientific and Technical Information of China (English)

    孙青龙; 董重谋; 黄锐; 王玉凤

    2012-01-01

      目的:探讨支架辅助机械解脱弹簧圈栓塞治疗颅内宽颈动脉瘤中的安全性、疗效、技术优势及临床应用价值。方法:采用 Seldinger 穿刺技术,应用颅内支架辅助瘤颈成形术结合 AxiumTM 弹簧圈栓塞治疗颅内宽颈动脉瘤26例。结果:所有动脉瘤均成功植入支架,其中 Boston 公司的 Neuroform 支架19枚、Cordis 公司的 Enterprise 支架7枚。术后即可完全填塞20例,大部分填塞6例,载瘤动脉通畅。术后随访6~12个月,未发现出血或脑血栓形成。结论:联合使用支架辅助机械弹簧圈栓塞是治疗颅内宽颈动脉瘤安全有效的方法,支架后释放技术显著提高动脉瘤颈覆盖率而达到血管重建目的,使宽颈动脉瘤的介入治疗成为可能,使颅内动脉瘤介入治疗技术成功率、安全性和疗效得到进一步提高。%  Objective:To discuss the safety,efficacy and advantages , the clinical application of stent -assisted mechanically -de-techable coil embolization in treating intracranial wild -necked aneurysms.Method:Twenty -six patients with wild -necked aneurysms were treated with embolization therapy by stent -assisted technique combined with the use of mechanically -detechable AxiumTMcoil through Seldinger technique .Results:Stent placement successed Technically in all of the wild -necked aneurysms,including 19 Boston Neuroform stent,7Cordis Enterprise stent.Total occlusion was achieved immediately in 20 cases and more than 90% in 6 cases,the pa-tients recovered well with patency of the parent arteries .All the patients recovered well.Neither rebleeding nor thrombosis -related sym-potoms occurred during a follow -up period of 6 -12months.Conclusion:For the treatment of intracranial wild -necked aneurysms, stent -assisted mechanically -detechable coil embolization technique is safe and effective .Stenting after coiling techniques can facili -tate the improvement of neck forvascular

  9. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study.

    Science.gov (United States)

    Pierot, Laurent; Costalat, Vincent; Moret, Jacques; Szikora, Istvan; Klisch, Joachim; Herbreteau, Denis; Holtmannspötter, Markus; Weber, Werner; Januel, Anne-Christine; Liebig, Thomas; Sychra, Vojtech; Strasilla, Christoph; Cognard, Christophe; Bonafé, Alain; Molyneux, Andrew; Byrne, James V; Spelle, Laurent

    2016-05-01

    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 monitor. Six-month follow-up digital subtraction angiography was also performed and independently analyzed by a core laboratory. Success was defined at 6 months as complete occlusion or stable neck remnant, no worsening in angiographic appearance from postprocedure, and no retreatment performed or planned. 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 in a permanent deficit (modified Rankin Scale [mRS] Score 1) in 1 patient (2.0%). Intraoperative rupture was not observed. Morbidity (mRS score > 2) and mortality were 2.0% (1 of 51 patients, related to rupture status on entry to study) and 0.0% at 1 month, respectively. Success was achieved at 6 months in 85.4% of patients treated with WEB: 23 of 41 patients (56.1%) had complete occlusion, 12 of 41 (29.3%) had a neck remnant, and 6 of 41 (14.6%) had an aneurysm remnant. CONCLUSIONS The WEBCAST study showed good procedural and short-term safety of aneurysm treatment with WEB and good 6-month anatomical results.

  10. Factors associated with outcomes in ruptured aneurysmal patients: Clinical Study of 80 Patients

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    Alfotih Gobran Taha Ahmed

    2015-03-01

    Full Text Available Background: Due to insufficient data in the literature, the optimal timing for surgical intervention for ruptured intracranial aneurysms is still controversial. Some practitioners advocate early surgery, but others not. It is important to identify other factors that can be used to predict poor prognosis in ruptured intracranial aneurysm patients. Objective: To determine the influence of timing of clipping surgery, and other factors on the outcomes of ruptured intracranial aneurysms in Hunt & Hess I~III grade patients. Method: We have performed a retrospective study involving 80 patients who were surgically treated for ruptured intracranial aneurysm between 2007 and 2012. The patient population consisted of 50(62.5% females and 30(37.5% males, with an age range of 12 to 75 years old, mean age 52.33 ± 10.63 years. We measured association between the Glasgow Outcome Scores and Sex, timing of clipping surgery, aneurysm location and pre-operative patient's neurological condition using famous Hunt and Hess grade system. Results: We did not find any correlation between the outcomes of ruptured intracranial aneurysm patients and timing (early, intermediate, late stage of clipping, sex, aneurysm location. Whereas there is a significant correlation between patients outcomes and pre-operative patient neurological condition (Hunt & Hess grade. Conclusion: Timing of Surgery (early, intermediate, late does not affect outcomes in low Hunt and Hess grade patients I~III. Whereas neurological condition (Hunt & Hess has strong impact on postoperative outcomes. Others factors like sex, Age, Aneurysm location have no effect on outcomes in ruptured intracranial aneurysms.

  11. [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.

  12. Paraclinoid aneurysm concealed by sphenoid wing meningioma.

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    Petrecca, Kevin; Sirhan, Denis

    2009-02-01

    The coexistence of brain tumours and aneurysms is rare. In all previously reported cases the aneurysm was detectable by angiography. We report here a case in which a paraclinoid internal carotid artery aneurysm was coexistent and concealed from angiographic detection by an adjacent parasellar meningioma.

  13. Blister-like aneurysms of the supraclinoid internal carotid artery: challenging endovascular treatment with stent-assisted coiling.

    Science.gov (United States)

    Ahn, Jung Yong; Cho, Jun Hyung; Jung, Jin Young; Lee, Byung Hee; Yoon, Pyeong Ho

    2008-09-01

    ''Blister-like'' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.

  14. Giant aneurysm of the distal anterior cerebral artery simulating brain tumor on CT scan

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    Shigemori, Minoru; Kawaba, Tomoyuki; Kuramoto, Shinken (Kurume Univ., Fukuoka (Japan). School of Medicine); Ogata, Takeyuki; Yoshimura, Kyoko

    1982-08-01

    A successfully treated case with a giant aneurysm of the distal anterior cerebral artery which simulated brain tumor on computerized tomography (CT) is reported. In a 69-year-old woman suffering with a mild headache and a weakness in the left leg, a plain skull film revealed a ballooning of the sella turcica and an erosion of the dorsum. A CT scan showed a round or oval high-density area at the medial site of the right frontal lobe which was associated with an extensive low-density area. Curviliner calcification was also noted. A marked attenuation of the medial site of the mass lesion was demonstrated with contrast enhancement. A left-carotid angiogram demonstrated a large aneurysm at the distal-branching point of the anterior cerebral artery. Radical treatment for the aneurysm was performed. The postoperative course was uneventful, and the low-density area around the aneurysm disappeared within 6 weeks after the operation.

  15. Tailored PICA Revascularization for Unusual Ruptured Fusiform Vertebro-PICA Origin Aneurysms: Rationale and Case Illustrations.

    Science.gov (United States)

    Carlson, Andrew P

    2015-11-01

    Ruptured fusiform aneurysms of the vertebral artery involving posterior inferior cerebellar artery (PICA) origin are difficult to manage without sacrificing PICA. In this report, two very unusual cases are described which highlight different revascularization strategies that may be required. The first case initially appeared to be a small saccular PICA origin aneurysm, but detailed angiography showed a serpentine recanalization of a fusiform aneurysm. This was treated with PICA-PICA anastomosis and trapping of the aneurysm. The second case is a dissecting vertebral aneurysm with both PICA and the anterior spinal artery originating from the dome. PICA was found to be a bihemispheric variant, so no in situ bypass was available, and an occipital artery to PICA bypass was performed. The vertebral artery was occluded proximally only and follow-up angiography showed remodeling of the distal vertebral artery with the anterior spinal artery filling by retrograde flow from the distal vertebral artery. These cases illustrate both the anatomic variability of this region as well as the need to be familiar with multiple treatment strategies including revascularization techniques to be able to successfully treat these aneurysms.

  16. Battle of the Bulge: Aortic Aneurysm Management From Early Modernity to the Present.

    Science.gov (United States)

    Barr, Justin

    2017-02-21

    For centuries, physicians have recognized aortic aneurysms as an acute threat to life. Therapeutic approaches to the disease began in the 18th century when leading physicians, such as René Laennec and Antonio Valsalva, applied research on circulation and blood coagulation to devise whole-body fasting and bleeding regimens to prevent rupture. After John Hunter's success in ligating arteries to treat peripheral aneurysms, surgeons attempted analogous operations on the aorta, but even the renowned Sir Astley Cooper and William Halsted met with disastrous results. Other clinicians tried various methods of creating intraluminal clots, including the application of such new technologies as electricity and plastic. Vessel repair techniques, pioneered by Alexis Carrel and others in the 20th century, eventually provided a reliably effective treatment. In the past few decades, minimally invasive methods that approach aneurysms endovascularly through small groin incisions have been adopted. A successful 2005 congressional campaign to fund screening for aortic aneurysms brought the disease to national attention and symbolizes current confidence in curing it. Drawing on various published and unpublished sources, this paper elucidates the development of specific treatments for aortic aneurysms over time and more broadly addresses how medicine and surgery apply the knowledge and technology available in particular eras to treat a specific, identifiable, and lethal disease. Examining the evolution of these therapeutic efforts unveils broader trends in the history of medicine. This allows aortic aneurysms to serve as a case study for exploring shifting philosophies in medical history.

  17. Granulomatous encephalitis, intracranial arteritis, and mycotic aneurysm due to a free-living ameba.

    Science.gov (United States)

    Martínez, A J; Sotelo-Avila, C; Alcalá, H; Willaert, E

    1980-01-01

    Primary amebic meningoencephalitis and granulomatous amebic encephalitis are well recognized clinicopathological entities caused by free-living amebas. Associated arteritis and "mycotic aneurysms" with infiltration of intracranial arteries by lymphocytes, amebic trophozoites and cysts have not been previously reported. A 26-month-old girl had a 3-week history of encephalitis, characterized, initially, by vomiting and low-grade fever. Subsequently, she developed ataxia, generalized weakness, lethargy, and esotropia. The first CSF showed 490 RBC/microliters, 705 WBC/microliters with 90% mononuclears. Her pupils reacted briskly to light. Moderate nuchal rigidity, nystagmus, fixed downward gaze, anisocoria, bilateral 6th nerve palsy, left arm monoparesis and left Babinski were present. CAT scan revealed slight symmetrical dilatation of anterior horns of lateral ventricles and an area of abnormal enhancement above the 3rd ventricle. She died 14 days after admission, 5 weeks after onset of symptoms. The brain showed focal necrotizing encephalopathy, involving thalami, cerebellum, brain stem, and cervical and upper thoracic spinal cord. Numerous free-living amebic trophozoites and cysts were present within a chronic granulomatous encephalitis. There were trombosis of basilar, posterior cerebral, and vertebral arteries with profuse chronic panarteritis, fibrinoid necrosis, and mycotic aneurysms.

  18. Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

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    Alberto Di Somma

    2014-01-01

    Full Text Available Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1 simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions; (2 dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries. Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered.

  19. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  20. Subarachnoid hemorrhage after aneurysm surgery

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    Carlos Gilberto Carlotti Junior

    1996-06-01

    Full Text Available The surgical treatment of intracranial aneurysms by clipping is recognized as effective and definitive. However some cases that suffered a new subarachnoid hemorrhage (SAH some time after they were submitted to aneurysm clipping have raised doubts about the concept of "cure"after this treatment. Eleven patients previously submitted to aneurysm clipping who presented a new SAH were analyzed. The time elapsed from surgery to SAH varied from 3 to 10 years. After SAH four patients had a poor outcome. The new episode of SAH occurred due to intrinsic factors of the cerebral vasculature: 1. a weak point of the vessel wall near the previous aneurysm, 2. a weak point of another vessel far from the previous aneurysm, 3. a previous infundibular dilation of the posterior communicating artery; and due to technical problems: 1. aneurysm not identified during the previous treatment, 2. aneurysm deliberately left untreated, 3. persistence of the aneurysm due to inappropriate surgery, 4. persistency of part of the aneurysm neck after clipping and 5. slipping of the clip from the neck of the aneurysm. The measures to prevent new SAH after surgery start with adequate preoperative angiographic studies, a careful inspection of the position of the clip and emptying of the aneurysm. Early angiography studies may reveal a persistent neck and later ones may reveal newly developed aneurysms. In conclusion, SAH after aneurysm clipping is a late and severe phenomenon and the concept of "cure" after this surgery should be interpreted with caution.O tratamento cirúrgico dos aneurismas cerebrais através de sua clipagem é reconhecido como eficaz e definitivo. Entretanto alguns casos sofrem nova hemorragia algum tempo após a cirurgia, deixando dúvidas sobre a "cura" pelo tratamento. Onze pacientes submetidos anteriormente a clipagem do aneurisma e que apresentaram nova hemorragia foram analisados. O intervalo de tempo da cirurgia para a nova hemorragia foi de 3 a 10 anos

  1. Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients

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    Balderi, Alberto, E-mail: balders@libero.it; Antonietti, Alberto, E-mail: antonietti.a@ospedale.cuneo.it; Pedrazzini, Fulvio, E-mail: pedrazzini.f@ospedale.cuneo.it; Sortino, Davide, E-mail: davide.sortino@hotmail.it; Vinay, Claudia, E-mail: claudia.vinay@gmail.com; Grosso, Maurizio, E-mail: grosso.m@ospedale.cuneo.it [AO Santa Croce e Carle Hospital, Department of Radiology (Italy)

    2013-10-15

    Purpose: The present study was performed to analyze the midterm results (five consecutive patients, 2-year follow-up) of the endovascular management of visceral artery aneurysms using the Cardiatis Multilayer Flow Modulator (CMFM) (Cardiatis, Isnes, Belgium), a self-expandable stent. Materials and Methods: From August 2009 to January 2011, we implanted five CMFMs in five patients (all men; mean age 73 years) to treat two common hepatic artery aneurysms, one celiac trunk aneurysm, one splenic artery aneurysm, and one superior mesenteric artery aneurysm (diameter 25-81 mm). The primary end point was technical success. The secondary end point was stent patency, absence of aneurysm rupture or reperfusion, and shrinking of the sac at 6-, 12-, and 24-month follow-up using computed tomography angiography. Follow-up ranged from 24 to 48 months (mean 31.2). Results: Technical success was achieved in all patients. Complete exclusion of the aneurysm with sac shrinking was achieved in two patients. Two stents became occluded at 6- and 24-month follow-up, respectively; both patients were asymptomatic and were not retreated. One patient developed sac reperfusion due to incomplete aneurysm exclusion. Conclusion: Long-term results in a wider population are needed to validate the effectiveness of the CMFM.

  2. Use of indocyanine green videoangiography during intracranial aneurysm surgery reduces the incidence of postoperative ischaemic complications.

    Science.gov (United States)

    Lai, Leon Tat; Morgan, Michael Kerin

    2014-01-01

    Microscope-integrated near-infrared indocyanine green videoangiography (ICGVA) has been shown to be a useful adjunct for intracranial aneurysm surgery. That the routine application of this technique reduces the risk of postoperative ischaemic complication, however, has not been reported. We present a retrospective matched-pair comparison of ICGVA guided aneurysm surgery versus historic control surgical cohort treated by the same author. Index patients and controls were matched for aneurysm size, location, patient demographics, risk factors, comorbidities, and surgical treatments. Ninety-one eligible patients with 100 intracranial aneurysms were treated using ICGVA assistance. There were no statistically significant differences between the two groups in terms of patient age, sex, risk factors, comorbidities and aneurysm characteristics. Of the 100 aneurysms in the ICGVA group, 107 investigations of ICGVA were performed. In 79 aneurysms (79.0%), ICGVA was considered useful but did not affect surgical management. In six patients (6.0%), ICGVA led to a crucial change of intraoperative strategies. In nine patients (9.0%), it was considered critical in assuring patency of small perforators. ICGVA was of no benefit in four patients (4.0%) and was misleading in two (2.0%). Postoperative ischaemic complications occurred in three patients (3.3%) in the ICGVA group compared with seven patients (7.7%) in the control group (paneurysm surgery as a safe and effective modality of intraoperative blood flow assessment. With all limitations of a retrospective matched-pair comparison, the use of ICGVA during routine aneurysm surgery reduces the incidence of postoperative ischaemic complications.

  3. Cavernous carotid artery pseudo-aneurysm treated by stenting in acromegalic patient Pseudoaneurisma da artéria carótida cavernosa tratado com "stent" em paciente acromegálica

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    Jorge Marcondes de Souza

    2003-06-01

    Full Text Available We report on a case of endovascular management of pseudoaneurysm of the cavernous segment of the internal carotid artery with covered stent reconstruction. A 36 years-old woman with a history of previous transsphenoidal approach for pituitary macroadenoma and false aneurysma formation was studied in a protocol that included balloon test occlusion and cerebral blood flow evaluation. An endovascular covered stent deployment in the area of the carotid laceration was performed with isolation of the aneurysm from the circulation and maintenance of the carotid flow. Helical angio-CT and cerebral digital subtraction angiography showed the carotid preservation without stenosis in the stented area. In conclusion, endovascular stent reconstruction for post-transsphenoidal carotid artery laceration and false aneurysm is demonstrated as useful technical adjunct in the management strategy and with the potential for carotid sacrifice morbidity avoidance.Relatamos um caso de manuseio com "stent" recoberto por pseudoaneurisma do segmento cavernoso da artéria carótida interna. A paciente de 36 anos, tinha história de cirurgia trans-esfenoidal para macroadenoma de hipófise e desenvolvimento de falso aneurisma na região cavernosa da ACI, foi estudado com protocolo para avaliação de reserva circulatória carotídea com teste de oclusão por balão e estudo de fluxo sanguíneo cerebral com tomografia computorizada de emissão de fóton único (SPECT. Instalação de "stent" recoberto no segmento lesado isolou o aneurisma da circulação, com manutenção do fluxo carotídeo. Angio-tomografia helicoidal e angiografia digital por subtração demonstraram a reconstrução carotídea sem estenose local. Em conclusão, reconstrução carotídea com "stent" recoberto é possível na estratégia para manuseio de pseudo-aneurisma com potencial para prevenção da morbidade do sacrifício terapêutico carotídeo.

  4. Glioblastoma and intracranial aneurysms: Case report and review of literature

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    Rushna Ali

    2015-01-01

    Conclusion: Several theories stand to explain the coincidental occurrence of intracranial aneurysms and GBM. The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage. No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

  5. Idiopathic thoracic aortic aneurysm at pediatric age.

    Science.gov (United States)

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  6. Combined treatment for complex intracranial aneurysm

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    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

  7. Hemiplegia cruzada associada a impressão basilar, malformação de Arnold-Chiari e siringomielia: relato de caso Cruciate hemiplegia associated with basilar impression, Arnold-Chiari malformation and syringomyelia: case report

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    José Alberto Gonçalves da Silva

    1996-12-01

    Full Text Available Os autores apresentam um caso de hemiplegia cruzada associada a impressão basilar, malformação de Arnold-Chiari e siringomielia. Discutem as propostas anatômicas e a fiopatogenia desta síndrome de ocorrência bastante rara.The authors report a case of cruciate hemiplegia associated with basilar impression, Chiari malformation and syringomyelia. The neuroanatomical controversy, the surgical treatment and the good outcome of the patient are discussed.

  8. Electrically evoked reticular lamina and basilar membrane vibrations in mice with alpha tectorin C1509G mutation

    Science.gov (United States)

    Ren, Tianying; He, Wenxuan

    2015-12-01

    Mechanical coupling between the tectorial membrane and the hair bundles of outer hair cells is crucial for stimulating mechanoelectrical transduction channels, which convert sound-induced vibrations into electrical signal, and for transmitting outer hair cell-generated force back to the basilar membrane to boost hearing sensitivity. It has been demonstrated that the detached tectorial membrane in mice with C1509G alpha tectorin mutation caused hearing loss, but enhanced electrically evoked otoacoustic emissions. To understand how the mutated cochlea emits sounds, the reticular lamina and basilar membrane vibrations were measured in the electrically stimulated cochlea in this study. The results showed that the electrically evoked basilar membrane vibration decreased dramatically while the reticular lamina vibration and otoacoustic emissions exhibited no significant change in C1509G mutation mice. This result indicates that a functional cochlear amplifier and a normal basilar membrane vibration are not required for the outer hair cell-generated sound to exit the cochlea.

  9. Treatment of complex intracranial aneurysms using flow-diverting silk® stents. An analysis of 32 consecutive patients.

    Science.gov (United States)

    Buyukkaya, Ramazan; Kocaeli, Hasan; Yildirim, Nalan; Cebeci, Hakan; Erdogan, Cüneyt; Hakyemez, Bahattin

    2014-12-01

    This study describes the peri-procedural and late complications and angiographic follow-up results of 32 patients with 34 complex aneurysms treated with flow diverter Silk stents in a single centre. In this retrospective study, 40 Silk stents (SS) were implanted in 34 complex intracranial aneurysms in 32 patients. In our series, 20 (58.8%) carotid-ophthalmic internal carotid artery (ICA), six (17.6%) cavernous ICA, two (5.9%) supraclinoid ICA, two (5.9%) petrosal ICA (the same patient- bilateral) and four (11.8%) posterior circulation aneurysms were treated. One of the posterior circulation lesions was a fenestrated-type aneurysm. Twenty wide-necked, saccular; eight neck remnant; four fusiform and two blister-like aneurysms were included in our series. SS were successfully implanted in all patients (100%). Misdeployment occurred in 17.6% of patients. In two of these patients adequate stent openness was achieved via Hyperglide balloon dilatation. Coil embolization in addition to SS placement was utilized in four aneurysms. One patient (3%) experienced transient morbidity due to a thromboembolic event and there was one mortality (3%) due to remote intraparenchymal haemorrhage. Complete occlusion of 27/33 (81.8 %) and 29/33 (87.9 %) aneurysms was achieved six and 12 months after the procedure, respectively. In-stent intimal hyperplasia was detected in 6.1 % patients. Flow-diverter Silk stent implantation is an effective method of treating complex aneurysms with acceptable mortality and morbidity rates. Complete occlusion is achieved in most of the complex aneurysms.

  10. A RARE CASE OF PERSISTENT TRIGEMINAL ARTERY IN AN ADULT FEMALE WITH PARA POSTERIOR COMMUNICATING ARTERY ANEURYSM

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    Banavathu Daya Bharath Singh

    2015-05-01

    Full Text Available Anastomosis found in the adulthood between the carotid and vertebro - basilar systems, apart from the posterior communicating artery, are extremely infrequent and are due to the persistence of vessels that joined both systems during the fetal period. This carotid - vertebrobasilar anastomosis are the trigeminal, otic, and hypoglossal and proatlantal arteries. P ersistent trigeminal artery is the commonest of the above mentioned four arteries. The reported incidence is about 0.2%. Patients may be asymptomatic or present symptoms due to low flow of posterior circulation or carotid microembolization from posterior circulation. PTA can cause trigemina l neuralgia. We report in this paper a case of a persistant trigeminal artery found in an adult female with a para p com aneurysm who had persistent trigeminal artery which was seen in C T angiogram .

  11. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms.

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    Teng-Fei Li

    Full Text Available The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms.Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy.The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence.The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.

  12. Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization

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    Cariati, Maurizio, E-mail: cariati.maurizio@sancarlo.mi.it [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Mingazzini, Pietro; Dallatana, Raffaello [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy); Rossi, Umberto G. [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Settembrini, Alberto [San Carlo Borromeo Hospital, Università degli Studi di Milano (Italy); Santuari, Davide [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy)

    2013-05-02

    Conventional endovascular therapy of thoracoabdominal aortic aneurysm with involving visceral and renal arteries is limited by the absence of a landing zone for the aortic endograft. Solutions have been proposed to overcome the problem of no landing zone; however, most of them are not feasible in urgent and high-risk patients. We describe a case that was successfully treated by total endovascular technique with a two-by-two chimney-and-periscope approach in a patient with acute symptomatic type IV thoracoabdominal aortic aneurysm with supra-anastomotic aneurysm formation involving the renal and visceral arteries and a pseduaneurismatic sac localized in the left ileopsoas muscle.

  13. Aortic graft infection and mycotic aneurysm with Streptococcus equi zooepidemicus: two cases with favorable outcome of antibiotic treatment.

    Science.gov (United States)

    Altreuther, Martin; Lange, Conrad; Myhre, Hans Olav; Hannula, Raisa

    2013-02-01

    Infections with Streptococcus equi zooepidemicus are rare and are associated with contact with animals or animal products. There are very few reports about infected vascular grafts or aneurysms with this etiology. We present two patients. The first is a 77-year-old man with an infected bifurcated graft four years after an open operation for an abdominal aortic aneurysm (AAA). The second is a 72-year-old man with a symptomatic mycotic AAA, treated with endovascular aneurysm repair. Both received prolonged treatment with bactericidal antibiotics and responded well. Follow-up time at present is 5.5 years for the first, and 4.5 years for the second, patient.

  14. Delayed type Ⅲb endoleak using AnacondaTM stent graft in abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    WU Zi-heng; Dieter Raithel; QU Le-feng

    2010-01-01

    @@ Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.1,2 Although type Ⅲb endoleaks (fabric defect) have been reported to occur in some divices,3-6 it has never been previously reported with the AnacondaTM endograft (Vascutek, Terumo, Scotland) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Here we report a delayed type Ⅲb endoleak of AnacondaTM endograft after EVAR for AAA.

  15. Effect of coil embolization on blood flow through a saccular cerebral aneurysm

    Indian Academy of Sciences (India)

    Vishal Agrawal; Chandan Paul; M K Das; K Muralidhar

    2015-05-01

    Coil embolization is a mildly invasive endovascular method for treatment of a cerebral aneurysm. The presence of a coil reduces fluid loading of the blood vessel and delays further deformation of the walls. Its effectiveness depends on the coil porosity and permeability apart from the nature of flow pulsations and its geometry. In the present work, a three dimensional numerical study of pulsatile flow of blood through an artery with saccular cerebral aneurysm is reported. The flow is unsteady but is taken to be laminar and incompressible. The coil is treated as homogeneous and isotropic porous medium. A comparative study has been carried out on aneurysms with and without a coil insert considering blood as a non-Newtonian fluid. The simulation is carried out for Reynolds numbers $Re$ = 500 and 1500. Results show that the velocity magnitude within the coil embolized aneurysm becomes negligible after coil insertion. The wall shear stress within the aneurysm decreases to a great extent for both Reynolds numbers. Pressure levels remain relatively unchanged. Overall, reduced wall loading with a coil stabilizes the growth of the aneurysm and thus provides an advantage.

  16. Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion.

    Science.gov (United States)

    Serbinenko, F A; Filatov, J M; Spallone, A; Tchurilov, M V; Lazarev, V A

    1990-07-01

    Nine patients with giant internal carotid artery (ICA) aneurysms (greater than 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficient on the basis of a strict preoperative testing protocol including: cerebral panangiography, electroencephalography, somatosensory potential recording, and cerebral blood flow monitoring during manual compression of the ICA in the neck. There were four intracavernous ICA aneurysms, four carotid-ophthalmic artery aneurysms, and one supraclinoid ICA aneurysm. All patients showed symptoms and signs of compression of the surrounding nervous structures. In the five cases of intradural lesions, the artery was occluded at the level of the aneurysm neck, so the ophthalmic artery had to be occluded. There was, nevertheless, no case of worsening of vision following surgery, and all nine patients showed significant improvement following the combined procedure. A combined EC-IC bypass procedure and endovascular ICA occlusion allows for immediate verification of the surgical results and appears to be a worthwhile method for treating giant intracranial aneurysms.

  17. Re-treatment rates after treatment with the Pipeline Embolization Device alone versus Pipeline and coil embolization of cerebral aneurysms: a single-center experience.

    Science.gov (United States)

    Park, Min S; Nanaszko, Michael; Sanborn, Matthew R; Moon, Karam; Albuquerque, Felipe C; McDougall, Cameron G

    2016-07-01

    OBJECT The optimal strategy for use of the Pipeline Embolization Device (PED, ev3 Neurovascular) has not been clearly defined. The authors examined re-treatment rates after treatment with PED alone versus PED and adjunctive coil embolization (PED/coil). METHODS The authors retrospectively examined cerebral aneurysms treated with the PED from May 2011 to March 2014. Overall, 133 patients (25 men, 108 women; mean age 60.4 years, range 23-85 years) were treated for 140 aneurysms (mean size 11.8 ± 8.3 mm) requiring 224 PEDs (mean 1.7 PEDs per patient). Sixty-eight patients (13 men, 55 women) were treated with PED alone for 73 aneurysms (mean size 10.6 ± 9.2 mm) and 65 patients (12 men, 53 women) were treated with PED/coil for 67 aneurysms (mean size 12.8 ± 7.4 mm). RESULTS Eight aneurysms in 8 patients were re-treated in the PED-alone cohort versus only 1 aneurysm in 1 patient in the PED/coil cohort for re-treatment rates of 11.8% (8/68) and 1.5% (1/65), respectively (p = 0.03). Two patients in the PED-alone cohort were re-treated due to PED contraction, while the other 6 were re-treated for persistent filling of the aneurysms. The PED/coil patient experienced continued filling of a vertebrobasilar artery aneurysm. No aneurysms in either group ruptured after treatment. CONCLUSIONS Adjunctive coil embolization during flow diversion with the PED resulted in a significantly lower re-treatment rate compared with PED alone, suggesting an added benefit with adjunctive coil embolization. This result may provide the basis for future evaluation with randomized, controlled trials.

  18. Comparison of P2X receptors in rat mesenteric, basilar and septal (coronary) arteries.

    Science.gov (United States)

    Lewis, C J; Evans, R J

    2000-07-01

    alpha beta meATP-evoked concentration-dependent, PPADS-sensitive, desensitising, P2X receptor-mediated, constrictions of mesenteric, basilar and septal artery rings with EC(50) values of 1, 1 and 30 microM, respectively. In patch clamp studies on acutely dissociated artery smooth cells alpha beta meATP-evoked transient inward currents (tau approximately 100 ms) with mean current densities of approximately 340, 175 and 120 pA/pF, respectively. P2X(1) receptor immunoreactivity was expressed in mesenteric and basilar arteries and this receptor subunit appears to dominate the P2X receptor phenotype in these vessels. In contrast P2X(1) receptor immunoreactivity was not detected in septal arteries and the alpha beta meATP sensitivity of constriction was not consistent with the involvement of P2X(1) receptors. These results suggest that not all arteries share a common P2X receptor phenotype.

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

    NARCIS (Netherlands)

    Goncalves, Frederico Bastos; Verhagen, Hence J. M.; Chinsakchai, Khamin; van Keulen, Jasper W.; Voute, Michiel T.; Zandvoort, Herman J.; Moll, Frans L.; van Herwaarden, Joost A.

    2012-01-01

    Objective: 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 Netherlands from

  20. Effect of Aneurysmal Subarachnoid Hemorrhage on Word Generation

    Directory of Open Access Journals (Sweden)

    Daniella Ladowski

    2014-01-01

    Full Text Available Background. Aneurysmal subarachnoid hemorrhage (aSAH survivors commonly exhibit impairment on phonemic and semantic fluency tests; however, it is unclear which of the contributing cognitive processes are compromised in aSAH patients. One method of disentangling these processes is to compare initial word production, which is a rapid, semiautomatic, frontal-executive process, and late phase word production, which is dependent on more effortful retrieval and lexical size and requires a more distributed neural network. Methods. Seventy-two individuals with aSAH and twenty-five control subjects were tested on a cognitive battery including the phonemic and semantic fluency task. Demographic and clinical information was also collected. Results. Compared to control subjects, patients with aSAH were treated by clipping and those with multiple aneurysms were impaired across the duration of the phonemic test. Among patients treated by coiling, those with anterior communicating artery aneurysms or a neurological complication (intraventricular hemorrhage, vasospasm, and edema showed worse output only in the last 45 seconds of the phonemic test. Patients performed comparably to control subjects on the semantic test. Conclusions. These results support a “diffuse damage” hypothesis of aSAH, indicated by late phase phonemic fluency impairment. Overall, the phonemic and semantic tests represent a viable, rapid clinical screening tool in the postoperative assessment of patients with aSAH.

  1. Mesenchymal stem cells for treatment of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    Aika; Yamawaki-Ogata; Ryotaro; Hashizume; Xian-Ming; Fu; Akihiko; Usui; Yuji; Narita

    2014-01-01

    An aortic aneurysm(AA) is a silent but life-threatening disease that involves rupture. It occurs mainly in aging and severe atherosclerotic damage of the aortic wall. Even though surgical intervention is effective to prevent rupture, surgery for the thoracic and thoraco-abdom-inal aorta is an invasive procedure with high mortality and morbidity. Therefore, an alternative strategy for treatment of AA is required. Recently, the molecular pathology of AA has been clarified. AA is caused by an imbalance between the synthesis and degradation of extracellular matrices in the aortic wall. Chronic inflam-mation enhances the degradation of matrices directly and indirectly, making control of the chronic inflamma-tion crucial for aneurysmal development. Meanwhile, mesenchymal stem cells(MSCs) are known to be ob-tained from an adult population and to differentiate into various types of cells. In addition, MSCs have not only the potential anti-inflammatory and immunosuppres-sive properties but also can be recruited into damagedtissue. MSCs have been widely used as a source for celltherapy to treat various diseases involving graft-versus-host disease, stroke, myocardial infarction, and chronicinflammatory disease such as Crohn’s disease clinically.Therefore, administration of MSCs might be availableto treat AA using anti-inflammatory and immnosup-pressive properties. This review provides a summary ofseveral studies on "Cell Therapy for Aortic Aneurysm"including our recent data, and we also discuss the pos-sibility of this kind of treatment.

  2. Treatment of ruptured intracranial aneurysms yesterday and now

    Science.gov (United States)

    Hammer, Alexander; Steiner, Anahi; Kerry, Ghassan; Ranaie, Gholamreza; Baer, Ingrid; Hammer, Christian M.; Kunze, Stefan; Steiner, Hans-Herbert

    2017-01-01

    Objective This prospective study is designed to detect changes in the treatment of ruptured intracranial aneurysms over a period of 17 years. Methods We compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. Specialists of neuroradiology and vascular neurosurgery decided over the modality assignment. We established a prospective data acquisition in both groups to detect significant differences within a follow-up time of one year. With this setting we evaluated the treatment methods over time and compared endovascular with microsurgical treatment. Results When compared to the earlier group, microsurgical treatment was less frequently chosen in the more recent collective because of neck-configuration. Endovascular treatment was chosen more frequently over time (31.9% versus 48.8%). Occurrence of initial symptomatic ischemic stroke was significantly lower in the clipping group compared to the endovascular group and remained stable over time. The number of reinterventions due to refilled treated aneurysms significantly decreased in the endovascular group at one-year follow-up, but the significantly better occlusion- and reintervention-rate of the microsurgical group persisted. The rebleeding rate in the endovascular group at one year follow-up decreased from 6.1% to 2.2% and showed no statistically significant difference to the microsurgical group, anymore (endovascular 2.2% versus microsurgical 0.0%, p = 0.11). Conclusion Microsurgical clipping still has some advantages, however endovascular treatment is improving rapidly. PMID:28257502

  3. Basilar invagination secondary to hypoplasia of the clivus - Is there indication for craniocervical fixation?

    OpenAIRE

    2014-01-01

    The posterior fossa decompression is a form of treatment suggested for patients with basilar invagination (BI) secondary to hypoplasia symptomatic of the clivus and atlantoaxial alignment preserved. Based on the fact that the worsening of cranial-cervical kyphosis (decrease of clivus-canal angle to less than 150o) can result in anterior brainstem compression, we propose that some patients may benefit from the cranio-cervical fixation. We present a case report of a patient with BI secondary to...

  4. Ruptured aneurysm of the hepatic artery: a mismatching diagnosis

    Directory of Open Access Journals (Sweden)

    Vincenzo Bua

    2013-04-01

    Full Text Available Background: Hepatic aneurysms are extremely rare with very few cases reported, and most have been source of misdiagnosis and clinical pitfalls in emergency medicine. Presentation with intraabdominal hemorrhage is associated with a high mortality rate. Case report: We report the case of an adult male, referred for a severe acute pain in the left lower chest-upper quadrant abdomen pain. We present multislice contrast-enhanced CT-scanning and angiographic findings, and a life-saving emergency trancatheter embolization, using fragments of absorbable gelatin sponge. Emergency doctors should consider ruptured hepatic artery aneurysms in the differential diagnosis of acute abdominal pain and promptly cooperate with endovascular specialists to treat this life-threatening condition.

  5. Megadolicho basilar artery as a cause of asymmetrical sensorineural hearing loss - case report

    Directory of Open Access Journals (Sweden)

    Melo, Antonio Antunes

    2011-07-01

    Full Text Available Introduction: At the differentiated diagnosis of asymmetrical sensorineural hearing losses, vascular disorders are present, one of which is megadolicho basilar artery. This disease is generally asymptomatic, and when symptoms are found, they can be caused by a compression or ischemia. Clinically, sensorineural hearing loss, tinnitus, headache, facial hypoesthesia, trigeminal neuralgia, vertigo, diplopia and facial palsy, among others, are likely to occur. The image examination of choice for its diagnosis is nuclear magnetic resonance. The megadolicho basilar artery therapy can be surgical or conservative, according to the associated findings. A multidisciplinary approach, including a neurologist, neurosurgeon and an otorhinolaryngologist is recommended for a proper administration of the case. Objective: Report the case of a patient with asymmetrical sensorineural hearing loss, diagnosed of megadolicho basilar artery. Case report: JBS, 57-year-old white male with a history of asymmetrical sensorineural hearing loss and bilateral whistle-like tinnitus for several years. The otorhinolaryngologic evaluation, including otoscopy, anterior rhinoscopy and oral pharynx, was normal. Final Comments: The treatment consisted in following up with the patient, controlling the tinnitus by drugs and using an individual sound amplification apparatus on the left ear.

  6. Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Hidenori Oishi

    2013-01-01

    Full Text Available We report a case of a ruptured distal anterior choroidal artery (AChoA aneurysm associated with moyamoya pattern collateralization secondary to the middle cerebral artery occlusion. Patient was successfully treated with the coil embolization of the distal AChoA. This case supports the feasibility and efficacy of the endovascular therapy for the distal AChoA aneurysms in patients with MCA occlusion with moyamoya pattern collateralization.

  7. A Rare Complication of Spinal Cord Ischemia Following Endovascular Aneurysm Repair of an Infrarenal Abdominal Aortic Aneurysm with Arteriosclerosis Obliterans: Report of a Case

    Science.gov (United States)

    Matsumoto, Takuya; Matsubara, Yutaka; Inoue, Kentaro; Aoyagi, Yukihiko; Matsuda, Daisuke; Tanaka, Shinichi; Okadome, Jun; Maehara, Yoshihiko

    2016-01-01

    We herein report a case of a rare complication of spinal cord ischemia (SCI) following endovascular aneurysm repair (EVAR). Computed tomography showed stenosis and calcification of bilateral iliac arteries and a saccular aneurysm of the terminal aorta. Paraplegia occurred soon after balloon angioplasty of iliac arteries and EVAR. Cerebrospinal fluid drainage was not performed because the patient was on dual antiplatelet drugs. The patient was treated with intravenous methylpredonisolone and naloxone; however, this did not improve his paraplegia. SCI after EVAR is extremely rare and unpredictable complication, however, physicians should be aware of SCI after EVAR in patients with atherosclerosis. PMID:27738476

  8. Aneurysm occlusion in elderly patients with aneurysmal subarachnoid hemorrhage : a cost-utility analysis

    NARCIS (Netherlands)

    Koffijberg, H.; Rinkel, G.J.; Buskens, E.

    2011-01-01

    BACKGROUND: Aneurysm occlusion after subarachnoid hemorrhage (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 dif

  9. Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage : a cost-utility analysis

    NARCIS (Netherlands)

    Koffijberg, H.; Buskens, E.; Rinkel, G. J. E.

    2011-01-01

    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 d

  10. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    OpenAIRE

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

  11. 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.

  12. Treatment of Intracranial Aneurysms with Flow Re-direction Endoluminal Device - A Single Centre Experience with Short-term Follow-up Results

    Science.gov (United States)

    Chong, Wing Ho; Lam, Samuel Siu Kei; Siu, Jimmy Chi Wai; Tan, Chong Boon; Wong, Yiu Chung

    2017-01-01

    Purpose A flow diverter (FD) is an effective treatment option for intracranial aneurysms. The Flow Re-direction Endoluminal Device (FRED) is a relatively new flow diverter with a unique dual-layer design. We report our experience and short-term results with the FRED. Materials and Methods We did a retrospective review of all consecutive cases in which the FRED was used to treat intracranial aneurysms at a single institution from March 2014 till December 2015. Clinical parameters, aneurysm characteristics, technical results and short-term outcomes were reviewed. Results Eleven intracranial aneurysms were treated with the FRED in 11 patients. The technical device deployment success rate was 100%. Immediate reduction in intra-aneurysmal flow after deployment was noted in 10 cases. The aneurysm occlusion rate at 6 months was 75%. There was 1 complication of in-stent thrombosis immediately after deployment. There was no side branch occlusion, delayed aneurysm rupture, stroke, or intraparenchymal haemorrhage. There was no neurological deficit, morbidity, or mortality. Conclusion The FRED is a new FD. It has shown to be safe and effective in our series. The unique dual-layer design of the device renders it to have technical advantages over other FDs. The 6-month aneurysm occlusion rate and complication profile of FRED are similar to other FDs. PMID:28316865

  13. Real time three-dimensional transthoracic echocardiography of ruptured left sinus of Valsalva aneurysm to left ventricle.

    Science.gov (United States)

    Kharwar, Rajiv Bharat; Narain, Varun Shankar; Sethi, Rishi

    2013-11-01

    Aneurysms arising from the sinus of Valsalva are a rare cardiac defect that can present with various signs and symptoms, and if not diagnosed and treated rapidly can lead to fatal outcomes. Unruptured aneurysms are usually asymptomatic and found incidentally during diagnostic studies. More commonly, aneurysm of sinus of Valsalva is detected after the occurrence of rupture. Echocardiography has become the investigative tool of choice for this condition, not only for diagnosis but also for quantification of severity. We hereby report a rare case of a 15-year-old patient presenting with complaints of effort dyspnea and palpitations. Two-dimensional transthoracic echocardiography (TTE) showed aneurysmal dilatation of left sinus of Valsalva which had ruptured into the left ventricle. Also, there was an intimal flap within the sinus of Valsalva aneurysm. The anatomical relationship between the aorta, aneurysm, and the left ventricle as well as the intimal flap within the aneurysm was clearly delineated with the help of three-dimensional TTE. After confirmation of the diagnosis with multidetector computed tomography, patient underwent successful surgical repair of the defect.

  14. Towards Predicting Patient-Specific Flow-Diverter Treatment Outcomes for Bifurcation Aneurysms: From Implantation Rehearsal to Virtual Angiograms.

    Science.gov (United States)

    Peach, T W; Spranger, K; Ventikos, Y

    2016-01-01

    Despite accounting for the majority of all cerebral aneurysm cases, bifurcation aneurysms present many challenges to standard endovascular treatment techniques. This study examines the treatment of bifurcation aneurysms endovascularly with flow-diverting stents and presents an integrative computational modeling suite allowing for rehearsing all aspects of the treatment. Six bifurcation aneurysms are virtually treated with 70% porosity flow-diverters. Substantial reduction (>50%) in aneurysm inflow due to device deployment is predicted in addition to reductions in peak and average aneurysm wall shear stress to values considered physiologically normal. The subsequent impact of flow-diverter deployment on daughter vessels that are jailed by the device is investigated further, with a number of simulations conducted with increased outlet pressure conditions at jailed vessels. Increased outlet pressures at jailed daughter vessels are found to have little effect on device-induced aneurysm inflow reduction, but large variation (13-86%) is seen in the resulting reduction in daughter vessel flow rate. Finally, we propose a potentially powerful approach for validation of such models, by introducing an angiographic contrast model, with contrast transport modeled both before and after virtual treatment. Virtual angiograms and contrast residence curves are created, which offer unique clinical relevance and the potential for future in vivo verification of simulated results.

  15. Treatment for spontaneous intracranial dissecting aneurysms in childhood: a retrospective study of 26 cases

    Directory of Open Access Journals (Sweden)

    Yisen Zhang

    2016-12-01

    Full Text Available Objective This study aimed to assess the clinicoradiological features and treatment outcome of intracranial dissecting aneurysms (IDAs in childhood.Methods We conducted a retrospective study of pediatric patients who were treated for spontaneous IDAs in our institute between January 2010 and December 2015. The clinical presentation, aneurysm characteristics, treatment modality, and outcome were studied. Results We studied 26 pediatric patients (mean age, 13.4 years; range, 4–18 years with 31 IDAs who comprised 6.9% of all IDA patients treated during the same period. Seventeen (65.4% patients were male and nine (34.6% were female. The incidence of large (≥10mm in size or giant aneurysms (≥25mm in size was 65.5%. Twenty-one (80.8% patients underwent endovascular or surgical treatment and five (19.2% received conservative treatment. Perioperative complications occurred in three patients, in whom two eventually recovered completely with a Glasgow Outcome Scale (GOS score of 5 and one partially recovered with a GOS score 4. Overall, 25 (96.2% patients had a favorable outcome and one (3.8% had an unfavorable outcome at a mean follow-up of 22.8 months (range, 6–60 months.Conclusions Pediatric IDAs are rare. In this series, endovascular management was a relatively safe and effective method of treatment for pediatric IDAs. However, continued follow-up is required because of the possibility of aneurysm recurrence and de novo aneurysm formation after treatment.

  16. Management of splenic artery aneurysm associatedwithextrahepaticportal veinobstruction

    Institute of Scientific and Technical Information of China (English)

    Pramod Kumar Mishra; Sundeep Singh Saluja; Ashok K Sharma; Premanand Pattnaik

    2012-01-01

    BACKGROUND: Splenic artery aneurysms although rare are clinically signiifcant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS:  The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically dififcult, it can be safely performed in an experienced center with minimal morbidity and good outcome.

  17. Pathomechanisms and treatment of pediatric aneurysms.

    Science.gov (United States)

    Krings, Timo; Geibprasert, Sasikhan; terBrugge, Karel G

    2010-10-01

    Pediatric aneurysms are rare diseases distinct from classical adult aneurysms and therefore require different treatment strategies. Apart from saccular aneurysms that are more commonly found in older children, three major pathomechanisms may be encountered: trauma, infection, and dissection. The posterior circulation and more distal locations are more commonly encountered in children compared to adults, and there is an overall male predominance. Clinical findings are not only confined to subarachnoid hemorrhage but may also comprise mass effects, headaches or neurological deficits. In traumatic aneurysms, the skull base and distal anterior communicating artery are commonly affected, and the hemorrhage occurs often delayed (2-4 weeks following the initial trauma). Infectious aneurysms are mostly bacterial in origin, and hemorrhage occurs early after a septic embolic shower. Dissecting aneurysms are the most often encountered aneurysm type in children and can lead to mass effect, hemorrhage, or ischemia depending on the fate of the intramural hematoma. Treatment strategies in pediatric aneurysms include endosaccular coil treatment only for the "classical berry-type" aneurysms; in the other instances, parent vessel occlusion, flow reversal, surgical options, or a combined treatment with bypass and parent vessel occlusion have to be contemplated.

  18. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. 1997.

    Science.gov (United States)

    Viñuela, Fernando; Duckwiler, Gary; Mawad, Michel

    2008-04-01

    From December 1990 to July 1995, the investigators participated in a prospective clinical study to evaluate the safety of the Guglielmi detachable coil (GDC) system for the treatment of aneurysms. This report summarizes the perioperative results from eight initial interventional neuroradiology centers in the United States. The report focuses on 403 patients who presented with acute subarachnoid hemorrhage from a ruptured intracranial aneurysm. These patients were treated within 15 days of the primary intracranial hemorrhage and were followed until they were discharged from the hospital or died. Seventy percent of the patients were female and 30% were male. The patients' mean age was 58 years old. Aneurysm size was categorized as small (60.8%), large (34.7%), and giant (4.5%); and neck size was categorized as small (53.6%), wide (36.2%), fusiform (6%), and undetermined (4.2%). Fifty-seven percent of the aueurysms were located in the posterior circulation and 43% in the anterior circulation. Eighty-two patients were classified as Hunt and Hess Grade I (20.3%), 105 Grade II (26.1%), 121 Grade III (30%), 69 Grade IV (17.1%), and 26 Grade V (6.5%). All patients in this study were excluded from surgical treatment either because of anticipated surgical difficulty (69.2%), attempted and failed surgery (12.7%), the patient's poor neurological (12.2%) or medical (4.7%) status, and/or refusal of surgery (1.2%). The GDC embolization was performed within 48 hours of primary hemorrhage in 147 patients (36.5%), within 3 to 6 days in 156 patients (38.7%), 7 to 10 days in 71 patients (17.6%), and 11 to 15 days in 29 patients (7.2%). Complete aneurysm occlusion was observed in 70.8% of small aneurysms with a small neck, 35% of large aneurysms, and 50% of giant aneurysms. A small neck remnant was observed in 21.4% of small aneurysms with a small neck, 57.1% of large aneurysms, and 50% of giant aneurysms. Technical complications included aneurysm perforation (2.7%), unintentional

  19. Pulmonary artery aneurysm with patent arterial duct: resection of aneurysm and ductal division.

    Science.gov (United States)

    Tefera, Endale; Teodori, Michael

    2013-10-01

    Congenital or acquired aneurysm of the pulmonary artery (PA) is rare. Although aneurysms are described following surgical treatment of patent ductus arteriosus (PDA), occurrence of this lesion in association with PDA without previous surgery is extremely uncommon. An eight-year-old patient with PDA and aneurysm of the main PA is described in this report. Clinical diagnosis of PDA was made upon presentation. Diagnosis of PA aneurysm was suspected on chest x-ray and was confirmed on transthoracic echocardiography. Successful surgical resection of the aneurysm and division of the duct were performed under cardiopulmonary bypass. The patient did well on follow-up both from clinical and echocardiographic point of view.

  20. [A case of successful treatment of concomitant ruptured intracranial aneurysm and visceral aneurysm].

    Science.gov (United States)

    Diogo, Cláudia; Baltazar, José; Fernandes, Mário

    2012-01-01

    The association between intracranial and visceral aneurysms is very rare, with a bad prognosis. The rupture usually appears in the Emergency Room, and it implies an immediate treatment. We describe the case of a woman with rupture of an anterior communicant artery aneurysm and rupture of a pancreatic duodenal artery aneurysm. The actuation of all specialties allowed the direct surgical treatment of the visceral aneurysm, without the aggravation of the cerebral hemorrhage that the eventual Aorta Artery clamping could provoke. The maintenance of the hemodynamic stability was essential for the posterior treatment of the intracranial aneurysm.

  1. One-off surgery of posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation

    Directory of Open Access Journals (Sweden)

    LIU Jia-gang

    2012-08-01

    Full Text Available Objective To investigate the surgical treatment and clinical results for the primary basilar invagination (BI with atlantoaxial dislocation (AAD. Methods A retrospective study was performed. The study included 89 patients who had primary BI and AAD were surgically treated in our hospital from January 2008 to December 2011. There were 28 males and 61 females, aged between 10 and 69 years (mean 45.42 years. All patients were treated by the same 3-step surgical method. The first step, reduction of the AAD was performed by homemade odontoid repositor intraoperatively through posterior approach; the second step, AO stainless steel plates were fixed between the occiput and C2, 3 lateral mass screws; and the third step, occipitocervical fusion were completed by autologous iliac crest graft. Operation effect was recorded during follow-up period. Results Follow-up period was 6 to 48 months. Clinical symptoms were improved in 82.93% patients after the surgery. Japanse Orthopaedic Association (JOA score increased from preoperative (8.80 ± 1.36 points to postoperative (15.35 ± 1.47 points (t = 17.225, P = 0.001. In general, satisfactory decompression and bony fusion were shown on postoperative radiological examinations for all patients. Compared with pretreatment data, the postoperative imaging measurement showed that the mean data of atlanto-dental interval (ADI, 9.22 mm vs 3.72 mm and vertical dimension from the top of odontoid process to Chamberlain line (10.41 mm vs 3.23 mm were all reduced, and the cervicomedullary angle (130° vs 150° and space available of spinal cord (SAC, 11.13 mm vs 15.54 mm were all improved. Conclusion The one-off surgery of posterior reduction technique and fixing between occiput and C2, 3 lateral mass screws is a safe, easy, and effective treatment for patients with p

  2. Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment Options, Outcomes, and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Flood, Karen, E-mail: karenrogers@doctors.org.uk; Nicholson, Anthony A. [Leeds Teaching Hospitals, Department of Radiology (United Kingdom)

    2013-06-15

    Purpose. To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Methods, Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Results. Outcome data collected between 3 months and 4 years (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. Conclusion. In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.

  3. Fever of unknown origin: Importance of 18F-FDG PET/CT in the diagnosis of a late infectious complication after aneurysm bypass.

    Science.gov (United States)

    Goudard, Y; Pierret, C; Dusaud, M; Falzone, E; Tourtier, J P; de Kerangal, X

    2011-09-01

    Persistent blood flow in aneurysmal sac after bypass-exclusion is well documented in the literature. Aneurysm enlargement, local compressive symptoms and even sac rupture are commonly described complications. Late secondary infection of popliteal artery aneurysm (PAA) following ligation and venous bypass is exceptional. We report the case of late PAA infection six years after bypass-exclusion in a 75 year-old man which was diagnosed by 18F-FDG PET/CT. The patient was successfully treated by aneurysm resection and antibiotics. The diagnosis of popliteal aneurysm infection is often clinical, echographic and sonographic, but computed tomography scan can be false negative in chronic low-grade infection. 18F-FDG PET/CT is able to accurately diagnose and localize infection with high sensibility and specificity.

  4. Idiopathic giant right atrial aneurysm

    Directory of Open Access Journals (Sweden)

    Santosh C Uppu

    2013-01-01

    Full Text Available A 2-year-old boy with an incidental finding of massive cardiomegaly on a chest X-ray was diagnosed with a giant right atrial aneurysm upon further investigation with echocardiography. The patient underwent successful surgical reduction of the right atrium and closure of the patent foramen ovale to prevent thromboembolic complications and to lower the risk of atrial arrhythmias. The resected atrium had paper-thin walls and pathological features of interstitial fibrosis with endocardial thickening.

  5. X-microstenting and transmesh coiling in the management of wide-necked tent-like anterior communicating artery aneurysms.

    Science.gov (United States)

    Cohen, José E; Melamed, Israel; Itshayek, Eyal

    2014-04-01

    Anterior communicating artery (AcomA) aneurysms frequently have wide necks and an irregular shape, incorporate parent vessels, and are associated with significant variations in vascular anatomy. Safe and complete endovascular occlusion of these aneurysms usually requires the assistance of combined approaches using balloons and stents in an individually tailored strategy. We describe a technique for X-configured stent-assisted coiling in the management of a small tricuspid tent-like wide-necked AcomA aneurysm by means of two crossed nitinol self-expandable Leo+ Baby stents (Balt Therapeutics, Montmorency, France) followed by "in stent" transmesh coiling. The addition of a low-profile stent into the neurointerventional armamentarium will substantially enhance our capability to treat previously uncoilable tent-like AcomA aneurysms.

  6. Endovascular aneurysm repair alters renal artery movement : A preliminary evaluation using dynamic CTA

    NARCIS (Netherlands)

    Muhs, Bart E.; Teutelink, Arno; Prokop, Matthias; Vincken, Koen L.; Moll, Frans L.; Verhagen, Hence J. M.

    2006-01-01

    Purpose: To observe the natural renal artery motion during cardiac cycles in patients with abdominal aortic aneurysm (AAA) and how the implantation of stent-grafts may distort this movement. Methods: Data on 29 renal arteries from 15 male patients (mean age 72.6 years, range 66-83) treated with Tale

  7. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment.

    NARCIS (Netherlands)

    Peeters, S.P.; Geest, I.C.M. van der; Rooy, J.W.J. de; Veth, R.P.H.; Schreuder, H.W.B.

    2009-01-01

    BACKGROUND: Aneurysmal bone cysts (ABCs) are most often treated with intralesional surgery (curettage) and additional bone grafting. There is debate on whether or not to use adjuvant therapy to decrease the local recurrence rate. This study is done to assess the outcome of curettage and cryosurgery

  8. Stent-grafting combined with transcatheter embolization for a ruptured isolated hypogastric artery aneurysm

    Institute of Scientific and Technical Information of China (English)

    DONG Zhi-hui; FU Wei-guo; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zheng-yu; WANG Yu-qi

    2006-01-01

    @@ Rupture of isolated hypogastric artery aneurysm (HAA) is rarely encountered and is associated with a high mortality rate. Conventional surgery can not achieve distal control easily and may cause substantial blood loss, yielding high operative morbidity and mortality. On March 17, 2005, we treated a patient with such a disease successfully by using endovascular stent-grafting combined with transcatheter embolization.

  9. Repair of an Atherosclerotic Coronary Artery Aneurysm by Implantation of a Coronary Covered Stent

    Directory of Open Access Journals (Sweden)

    Antenor Portela

    2002-05-01

    Full Text Available An atherosclerotic aneurysm of the right coronary artery complicated by a recent myocardial infarction was successfully treated with coronary artery stenting, using a device consisting of 2 stents with a layer of expandable polytetrafluorethylene (PTFE placed between them. A follow-up angiograph 5 months after the procedure showed sustained initial results.

  10. 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 RE

  11. 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 occ

  12. Growth rates of intracranial aneurysms : exploring constancy

    NARCIS (Netherlands)

    Koffijberg, Hendrik; Buskens, Erik; Algra, Ale; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    2008-01-01

    Object. The annual rate of rupture of intracranial aneurysms is often assumed to be constant, but it is unknown whether this assumption is true. Recent case reports have suggested that aneurysms grow fast in a short period of time. The authors of the present report investigated the plausibility of a

  13. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  14. Aneurysm of the Right Atrial Appendage

    Directory of Open Access Journals (Sweden)

    Silvio Henrique Barberato

    2002-02-01

    Full Text Available Atrial aneurysms involving the free wall or atrial appendage are rare entities in cardiology practice and may be associated with atrial arrhythmias or embolic phenomena. We review the literature and report a case of aneurysm of the right atrial appendage in a young adult, whose diagnosis was established with echocardiography after an episode of paroxysmal atrial flutter.

  15. Head positioning for anterior circulation aneurysms microsurgery

    Directory of Open Access Journals (Sweden)

    Feres Chaddad-Neto

    2014-11-01

    Full Text Available Objective To study the ideal patient's head positioning for the anterior circulation aneurysms microsurgery. Method We divided the study in two parts. Firstly, 10 fresh cadaveric heads were positioned and dissected in order to ideally expose the anterior circulation aneurysm sites. Afterwards, 110 patients were submitted to anterior circulation aneurysms microsurgery. During the surgery, the patient's head was positioned accordingly to the aneurysm location and the results from the cadaveric study. The effectiveness of the position was noted. Results We could determine mainly two patterns for head positioning for the anterior circulation aneurysms. Conclusion The best surgical exposure is related to specific head positions. The proper angle of microscopic view may minimize neurovascular injury and brain retraction.

  16. Sensitivity of Hyperdense Basilar Artery Sign on Non-Enhanced Computed Tomography.

    Directory of Open Access Journals (Sweden)

    Marielle Ernst

    Full Text Available The hyperdense basilar artery sign (HBAS is an indicator of vessel occlusion on non contrast-enhanced computer tomography (NECT in acute stroke patients. Since basilar artery occlusion (BAO is associated with a high mortality and morbidity, its early detection is of great clinical value. We sought to analyze the influence of density measurement as well as a normalized ratio of Hounsfield unit/hematocrit (HU/Hct ratio on the detection of BAO on NECT in patients with suspected BAO.102 patients with clinically suspected BAO were examined with NECT followed immediately by Multidetector computed tomography Angiography. Two observers independently analyzed the images regarding the presence or absence of HBAS on NECT and performed HU measurements in the basilar artery. Receiver operating characteristic curve analysis was performed to determine the optimal density threshold for BAO using attenuation measurements or HU/Hct ratio.Sensitivity of visual detection of the HBAS on NECT was relatively low 81% (95%-CI, 54-95% while specificity was high 91% (95%-CI, 82-96%. The highest sensitivity was achieved by the combination of visual assessment and additional quantitative attenuation measurements applying a cut-off value of 46.5 HU with 94% sensitivity and 81% specificity for BAO. A HU/Hct ratio >1.32 revealed sensitivity of 88% (95%-CI, 60-98% and specificity of 84% (95%-CI, 74-90%.In patients with clinically suspected acute BAO the combination of visual assessment and additional attenuation measurement with a cut-off value of 46.5 HU is a reliable approach with high sensitivity in the detection of BAO on NECT.

  17. Assessment of long-term effects of aneurysms trapping and extracranial-intracranial bypass surgery in patients with complex cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    MAO Zhi-qi

    2012-02-01

    Full Text Available Objective To study the long-term effects of extracranial-intracranial (EC-IC bypass and aneurysms trapping in patients with complex cerebral aneurysms. Methods Seventeen patients with complex aneurysms, who underwent EC-IC bypass and aneurysms trapping from 2008 to 2009, were followed up. Clinical records were reviewed, modified Rankin Scale (mRS was recorded at admission, discharging, and follow-up point, and activities of daily living (ADL scale (Barthel Index at admission and follow-up point. Results Seventeen patients (11 males and 6 females were followed up. At admission mRS scores were 1.06 ± 0.87, Barthel index 91.10 ± 10.30. Superficial temporal artery-middle cerebral artery (STA-MCA was performed in 8 cases, extracarotid artery-great saphenous vein-middle cerebral artery (ECA-GSV-MCA in 5 cases, extracarotid artery-radial artery-middle cerebral artery (ECA-RA-MCA in 3 cases, occipital artery-posterior inferior cerebellar artery (OA-PICA in 1 case. Patients were followed up for 19-39 months (mean 28.67 months. At follow-up point, 2 patients (11.76% died, operation-related mortality was 5.88% (1/17, operation-related morbidity 5.88% (1/17, mRS scores 1.07 ± 1.16, Barthel index 96.40 ± 10.30. Conclusion Patients with complex aneurysms who were impossible to be treated with surgical clipping or endovascular intervention could be cured with extracranial-intracranial bypass and aneurysms trapping, and good follow-up results were acquired.

  18. 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.

  19. [Aneurysm of the anterior inferior cerebellar artery: case report].

    Science.gov (United States)

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  20. Basilar invagination secondary to hypoplasia of the clivus - Is there indication for craniocervical fixation?

    Directory of Open Access Journals (Sweden)

    Andrei Fernandes Joaquim

    2014-03-01

    Full Text Available The posterior fossa decompression is a form of treatment suggested for patients with basilar invagination (BI secondary to hypoplasia symptomatic of the clivus and atlantoaxial alignment preserved. Based on the fact that the worsening of cranial-cervical kyphosis (decrease of clivus-canal angle to less than 150o can result in anterior brainstem compression, we propose that some patients may benefit from the cranio-cervical fixation. We present a case report of a patient with BI secondary to clivus hypoplasia who underwent cranio-cervical fixation in extension, with a reduction in clivus-canal angle and improvement of symptoms without posterior fossa decompression.

  1. Endovascular treatment of a giant internal carotid artery bifurcation aneurysm with drainage into cavernous sinus

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhen-hai; YANG Xin-jian; WU Zhong-xue; LI You-xiang; JIANG Peng

    2012-01-01

    This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus,which appeared following closed head trauma.A 39-year-old man suffered from a blunt head trauma in an automobile accident.Two weeks after the trauma,progressive chemosis of left eye was presented.Four months after the trauma,digital subtraction angiography showed an internal carotid artery bifurcation aneurysm,with drainage into the cavernous sinus.The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx.Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery.Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion.

  2. Infected aortic aneurysm presenting as prevertebral abscess in magnetic resonance imaging: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jung Re; Ko, Seong Joo; Heo, Sang Taek; Kim, Jin Seok; Kim, Seung Hyoung [Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2013-09-15

    The differential diagnosis of mass-like lesions around the aorta includes saccular pseudoaneurysms and abscesses. A 69-year-old female was admitted with multiple abscesses and fluid collections in several muscles and joints. Methicillin susceptible Staphylococcus aureus was isolated from her blood and pus. Even though she was treated with repeated operations and appropriate antibiotics, her conditions worsened with persistent fever and newly developed abscesses at other sites. Serial enhanced computed tomography (CT) revealed a newly developed saccular abdominal aortic aneurysm in the retroaortic space at the celiac axis level. However, the infected aortic aneurysm mimicked a prevertebral abscess on enhanced spinal magnetic resonance imaging (MRI) due to its heterogeneous signal intensity caused by intraaneurysmal turbulent blood flow. We report to alert the pitfall in the diagnosis of saccular aortic aneurysm using spinal MRI and the importance of serial enhanced CT study in highly suspicious patients.

  3. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic...... valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR.......An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic...

  4. [Percutaneous treatment of a superficial femoral artery aneurysm using an intravascular stent-prosthesis].

    Science.gov (United States)

    Michel, C; Laffy, P Y; Leblanc, G; Riou, J Y; Chaloum, S; Maklouf, M; Le Guen, O

    1999-05-01

    One case of superficial femoral aneurysm treated percutaneously by endovascular stent graft (Passager Boston) is reported. The initial radiographic evaluation included arteriography and color doppler sonography which enable analysis of the flow path, the extent of the wall thrombus, the choice of stended graft size. The procedure of implantation was technically trouble free. The post-procedure 3D CT and arteriography demonstrated occlusion of the aneurysm and resaturation of normal flow path. The six and twelve month check confirmed the stability of the results locally and the integrity of run off vessels. In weakened and specially elderly patient percutaneous treatment of superficial femoral artery aneurysm can be carried out easily. The contribution of 3D CT is essential in follow up to ensure an optimal result and to detect any complication.

  5. A discussion of the optimal treatment of intracranial aneurysm rupture in elderly patients.

    Science.gov (United States)

    Liu, C

    2014-08-25

    This study aimed to find an optimal treatment for intracranial aneurysm rupture in elderly patients. We adopted endovascular embolization and combined it with mini-invasive aspiration, vascular stenosis stenting, and rehabilitation training to treat 13 elderly patients with intracranial aneurysm rupture. When the 13 patients were discharged and evaluated by the Glasgow Outcome Score (GOS), 7 patients were grade 5, 4 patients were grade 4, and 2 patients were grade 2. We found that a combination of endovascular embolization with mini-invasive aspiration and vascular stenosis stenting allowed us to adapt this treatment to various types of aneurysms. Our approach is especially suitable for elderly patients, because it reduces the occurrence of complications, improves patient prognoses, shortens the duration of hospitalization, and improves the quality of life.

  6. [The treatment of abdominal aortic aneurysms by use of endovascular prosthesis and classic vascular prosthesis].

    Science.gov (United States)

    Pupka, Artur; Szyber, Przemysław P; Janczak, Dariusz; Pawłowski, Stanisław; Szyber, Piotr

    2006-01-01

    The abdominal aortic aneurysm is a dilatation of infrarenal part of aorta. Its ethiology is still unknown. An infection and congenital disorders of conjunctive tissue are regarded as the main risc factors. Other factors could be a perimural thrombus and elastin and colagen degradation. It's not proved that atheromatosis is a risc factor. The disease concerns mainly the old males. Not treated aneurysm grows until rupture. The aneurysms are usually asympthomatic. Majority of them are found incidentally. Ultrasonography and computed tomography are used to extended diagnosis. The open surgery or endovascular surgery are only possible ways of treatment. The aneurysm with diameter over 55 milimeters, sympthomatic or rupted is an indication for surgery. The aim of the open surgery is implantation of the vascular prosthesis into retroperitoneal space. Endovascular method consist in placement of stent-graft in the lumen of aneurysm through small incision in a peripherial vessel. Stent-graft consists of metal chassis covered by classic vascular prosthesis. This method still requires the long-term assessment.

  7. Ortner's Syndrome: Secondary Laryngeal Paralysis Caused by a Great Thoracic Aorta Aneurysm

    Directory of Open Access Journals (Sweden)

    Zangirolami, Ana Claudia Alves

    2015-01-01

    Full Text Available Introduction Recurrent laryngeal nerve injury caused by cardiovascular disease is a rare condition, and often it is the only prominent sign of an imminent break of an aortic artery aneurysm. Objective To report left laryngeal paralysis caused by a great aortic arch aneurysm and to highlight the importance of an otorhinolaryngologic evaluation along with a thoracic radiologic study. Resumed Report A 42-year-old man complained of thickness of his voice and dysphagia for 3 months, but no thoracic pain or other relevant complaints. Video laryngoscopy revealed immobility of his left vocal fold in the paramedian position. Imaging was obtained for investigation, including magnetic resonance imaging of his thorax, which showed a fusiform aneurysm in the aortic arch, leading to recurrent compression of the left laryngeal nerve. The patient was successfully treated with endovascular repair of the aneurysm. At 2-month follow-up, there was still no recovery of the laryngeal mobility. Conclusion An aortic artery aneurysm can suddenly break, requiring emergency heart surgery, and the results can be fatal in many cases. We suggest routine exam of the vocal folds in all patients with a heart condition, and we review the literature and suggest the use of imaging to reduce the number of emergency procedures.

  8. Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms

    Institute of Scientific and Technical Information of China (English)

    刘建民; 黄清海; 许奕; 洪波; 张珑; 张鑫

    2004-01-01

    Background Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape, making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination of stents and coils.Methods From October 2000 to July 2001, eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling.Results Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting, and total occlusion was obtained in 13 cases, neck remnants in 3, and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization.Conclusions A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the long-term outcome.

  9. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  10. 球囊扩张Apollo支架植入术治疗症状性基底动脉狭窄%Treatment of symptomatic basilar artery stenosis with balloon expandable Apollo stent

    Institute of Scientific and Technical Information of China (English)

    张帆; 蔡玉琴; 郭贵军; 郜利会; 吕彦锋; 徐国栋; 孟庆溪

    2012-01-01

    Objective To observe the safety and effectiveness of balloon expandable Apollo stent for the treatment of symptomatic basilar artery stenosis. Methods Eighteen patients with symptomatic basilar artery stenosis (all >70%) were treated with Apollo stent The mean time of clinical follow-up was 11 months. Clinical evaluation was performed based on the modified Rankin Scale (mRS). Results The stent placement was technically successful in all 18 patients. Clinical symptoms were improved in 16 patients after stenting. The mRS scores of 14 patients after stenting were ≤2, while of 4 patients were >2. Conclusion Balloon expandable Apollo stem placement is a safe and efficacious alternative for the treatment of symptomatic basilar stenosis.%目的 观察球囊扩张支架植入术治疗症状性基底动脉狭窄的疗效及安全性.方法 应用Apollo支架治疗18例症状性基底动脉严重狭窄(>70%)患者,术后平均随访11个月,以改良Rankin量表(mRS)评分为基础评价治疗效果.结果 对所有患者均成功植入支架,16例患者临床症状得到不同程度改善;18例中,14例mRS评分≤2分,4例mRS评分>2分.结论 球囊扩张支架植入术治疗症状性基底动脉狭窄安全、有效.

  11. Haemodynamics of giant cerebral aneurysm: A comparison between the rigid-wall, one-way and two-way FSI models

    Science.gov (United States)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Bobkova, M. S.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper a computer simulation of a blood flow in cerebral vessels with a giant saccular aneurysm at the bifurcation of the basilar artery is performed. The modelling is based on patient-specific clinical data (both flow domain geometry and boundary conditions for the inlets and outlets). The hydrodynamic and mechanical parameters are calculated in the frameworks of three models: rigid-wall assumption, one-way FSI approach, and full (two-way) hydroelastic model. A comparison of the numerical solutions shows that mutual fluid- solid interaction can result in qualitative changes in the structure of the fluid flow. Other characteristics of the flow (pressure, stress, strain and displacement) qualitatively agree with each other in different approaches. However, the quantitative comparison shows that accounting for the flow-vessel interaction, in general, decreases the absolute values of these parameters. Solving of the hydroelasticity problem gives a more detailed solution at a cost of highly increased computational time.

  12. 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.

  13. Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature

    Directory of Open Access Journals (Sweden)

    Menon Girish

    2007-01-01

    one person rebled while defecating. Nine patients were taken up for emergency exploration immediately after rebleeding. From these, six patients died and three survived, but were severely disabled. The remaining eleven patients who were conservatively treated expired after varying periods of intensive care. Conclusions: Our incidence of rebleeding (2.14% is considerably less than most of the other reported series, probably related to the delayed referral pattern. Probable predisposing factors for rebleed include old age, female sex and an anterior communicating artery location. Known risk factors such as hypertension, poor neurological grade on admission, stressful activity and aneurysm morphology do not appear to be significant in our study. Outcome is extremely poor following the rebleeds, either in immediate surgery or conservative treatment.

  14. Endothelin-1 and endothelin receptors in the basilar artery of the capybara.

    Science.gov (United States)

    Loesch, Andrzej; Gajkowska, Barbara; Dashwood, Michael R; Fioretto, Emerson T; Gagliardo, Karina M; Lima, Ana R De; Ribeiro, Antonio A C M

    2005-02-01

    Little is known about cerebral vasculature of capybara, which seems may serve as a natural model of studying changes in cerebral circulation due to internal carotid artery atrophy at animal sexual maturation. This is the first study of the light- and electron-immunocytochemical localisation of endothelin-1 (ET-1) and ETA and ETB endothelin receptors in the basilar artery of capybaras (6 to 12-month-old females and males) using an ExtrAvidin detection method. All animals examined showed similar patterns of immunoreactivity. Immunoreactivity for ET-1 was detected in the endothelium and adventitial fibroblasts, whilst immunoreactivity for ETA and ETB receptors was present in the endothelium, vascular smooth muscle, perivascular nerves and fibroblasts. In endothelial cells immunoreactivity to ET-1 was pronounced in the cytoplasm or on the granular endoplasmic reticulum. Similar patterns of immunolabelling were observed for ETA and ETB receptors, though cytoplasmic location of clusters of immunoprecipitate seems dominant. These results suggest that the endothelin system is present throughout the wall of the basilar artery of capybara.

  15. High cervical C3-4 ′disc′ compression associated with basilar invagination

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    Goel Atul

    2008-01-01

    Full Text Available A 20-year-old male had torticollis and short neck since birth. He presented with symptom of progressive quadriparesis over a two-year period. Investigations revealed basilar invagination with marked rotation in the craniovertebral region and relatively large C3-4 region osteophytes. Serial MRI over two years showed persistent signal opposite C3-4 disc space suggestive of cord compression. Although the cord was humped over the odontoid process, there was no clear radiological evidence that the cord was compromised at this level. During surgery, instability was identified only at the craniovertebral region and not at the level of C3-4. Distraction of the lateral masses of atlas and axis and fixation using interarticular spacers and bone graft and direct screw implantation in the lateral mass of the atlas and pars of the axis resulted in reduction of the basilar invagination and of atlantoaxial dislocation. The patient had marked clinical recovery, despite the fact that no direct procedure was done for C3-4 disc decompression. The case suggests that C3-4 disc changes could be secondary to primary instability at the craniovertebral junction.

  16. 'Top of the basilar' syndrome. Clinico-radiological evaluation

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    Sato, Masaharu; Kuroda, Ryotaro; Nakatani, Jiro; Watanabe, Masaru; Akai, Fumiharu; Ioku, Masahiko

    1988-06-01

    Seventeen patients (age 23 - 81) having the ''top of the basilar'' syndrome were the subjects of this study. They were evaluated clinico-radiologically. The diagnosis of this syndrome was made by computerized tomography. The infarcted lesions of each patient were widely distributed in many areas among the thalamus, midbrain, pons, cerebellum, and occipital lobe. Both the thalami were involved in 8 patients. When the thalamus was involved bilaterally, the low density areas of both the thalami were demonstrated to be almost the same in size and symmetric in localization by computerized tomography, showing a characteristic pattern. Further, magnetic resonance imaging could reveal small lesions in the brain stem minutely. Angiography revealed that stenosis or occlusion was within the circle of 2 cm in diameter surrounding the five-forked road of the top of the basilar artery in 84.6 %. Recanalization of the occluded artery occurred in 61.5 %, which suggests that the embolism plays an important role in appearance of this syndrome. In spite of frequent recanalization hemorrhagic infarction never occurred. The prognosis was very poor.

  17. Complications of endovascular treatment of cerebral aneurysms.

    Science.gov (United States)

    Orrù, Emanuele; Roccatagliata, Luca; Cester, Giacomo; Causin, Francesco; Castellan, Lucio

    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.

  18. Complications of endovascular treatment of cerebral aneurysms

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    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.

  19. Cerebral Aneurysm in the Evolution of Cardiac Myxoma: Clinical and Physiopathological Interpretations; El aneurisma cerebral en la evolucion del mixoma cardiaco: planteamientos clinicos y fisopatologicos

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, R.; Garcia, M. L. [Hospital General Universitario Morales Meseguer. Murcia (Spain)

    2003-07-01

    We present the case of a patient with stroke, cerebral aneurysms (small distal and large proximal) who had been treated for cardiac myxoma 18 years earlier. We compared the imaging findings (localization, size, density and associated cerebral lesions) with those of other publications. The data obtained from other works and those that we could derive from our patient suggest that the cerebral aneurysms are responsible for neurological symptoms observed some time after removal of the tumor. On the other hand, such aneurysms tend to grow larger and more proximal with increasing time after surgery. (Author) 15 refs.

  20. Aneurisma de hiperfluxo próprio da artéria comunicante posterior decorrente de efeito hemodinâmico em paciente com oclusão da artéria subclávia tratado por angioplastia High flow"true" posterior communicating artery aneurysm due to hemodynamic effect in a patient with subclavian artery occlusion treated with angioplasty

    Directory of Open Access Journals (Sweden)

    José Maria Modenesi Freitas

    2005-09-01

    Full Text Available Aneurismas próprios da artéria comunicante posterior são extremamente raros possuindo uma incidência que varia de 0,1 a 2,8% de todos os aneurismas. O surgimento de aneurisma intracraniano em virtude de alterações de fluxo por oclusão arterial é descrito na literatura. Apresentamos o caso de homem de 69 anos, vítima de hemorragia subaracnóidea, com diagnóstico de aneurisma próprio da artéria comunicante posterior direita. Havia também, oclusão da artéria subclávia esquerda com roubo de fluxo da artéria vertebral direita pela vertebral esquerda. Realizou-se tratamento endovascular com angioplastia e colocação de stent na artéria subclávia esquerda com conseqüente oclusão do aneurisma. Discutimos o restabelecimento do fluxo arterial intracraniano como forma de tratamento deste aneurisma.True posterior communicating artery aneurysms are extremely rare with incidence ranges from 0.1% to 2.8% of all aneurysms. Cerebral aneurysm formation has been reported as a complication of artery occlusion by flow alteration. We present a 69 years old male patient presenting with subarachnoid hemorrhage with diagnosis of true right posterior communicating artery aneurysm. He had a left subclavian artery occlusion with flow theft from the right vertebral artery to the left vertebral artery. The patient underwent endovascular treatment with angioplasty and stent placement on the left subclavian artery and aneurysm occlusion result. We discuss the restablishment of cerebral blood flow as a treatment for this aneurysm.

  1. Endovascular treatment of popliteal artery aneurysm. Early and midterm results

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    Rodrigo Borges Domingues

    2015-02-01

    Full Text Available OBJECTIVE: to evaluate the efficacy of endovascular repair of popliteal artery aneurysms on maintaining patency of the stent in the short and medium term. METHODS: this was a retrospective, descriptive and analytical study, conducted at the Integrated Vascular Surgery Service at the Hospital da Beneficência Portuguesa de São Paulo. We followed-up 15 patients with popliteal aneurysm, totaling 18 limbs, treated with stent from May 2008 to December 2012. RESULTS: the mean follow-up was 14.8 months. During this period, 61.1% of the stents were patent. The average aneurysm diameter was 2.5cm, ranging from 1.1 to 4.5cm. The average length was 5cm, ranging from 1.5 to 10 cm. In eight cases (47.1%, the lesion crossed the joint line, and in four of these occlusion of the prosthesis occurred. In 66.7% of cases, treatment was elective and only 33.3% were symptomatic patients treated on an emergency basis. The stents used were Viabahn (Gore in 12 cases (66.7%, Fluency (Bard in three cases (16.7%, Multilayer (Cardiatis in two cases (11.1% and Hemobahn (Gore in one case (5.6%. In three cases, there was early occlusion (16.6%. During follow-up, 88.2% of patients maintained antiplatelet therapy. There was no leakage at ultrasound (endoleak. No fracture was observed in the stents. CONCLUSION: the results of this study are similar to other published series. Probably, with the development of new devices that support the mechanical characteristics found on the thighs, there will be improved performance and prognosis of endovascular restoration.

  2. Primitive trigeminal artery-cavernous sinus fistula and ICA-primitive trigeminal artery aneurysm:report of two cases and review of literatures

    Institute of Scientific and Technical Information of China (English)

    GUO Yuan-xing; LI Tie-lin; DUAN Chuan-zhi; WANG Qiu-jing; HUANG Qing

    2004-01-01

    The authors described two cases with primitive trigeminal artery. Case 1 was a 32-year-old woman who suffered dizziness and a serious pulsatile intracranial bruit on the left ear, and sometimes associated with pulsatile intracranial bearing-pain on the left temporal side six months before she was admitted to the hospital. She also suffered from obvious diplopia on left lateral gaze for the last 5 months. She had suffered no recent trauma. Magnetic resonance imaging(MRI) demonstrated a suspected intracranial aneurysm located in left cavernous sinus. Digital subtraction angiography (DSA) was performed and a primitive trigeminal artery-cavernous sinus fistula in left side was found. Intraluminal occlusion of the fistula was successfully performed immediately after angiography using 6 Guglielmi detachable coils (GDC), and the patient was cured finally. Case 2 was a 28-year-old woman who suffered a serious intermittent cephalodynia associated with soreness on the left body two years before she was admitted to the hospital. She had suffered no recent trauma. Magnetic resonance angiography(MRA) demonstrated a suspected intracavernous aneurysm of the right internal carotid artery, Digital subtraction angiography (DSA) was performed. Right internal carotid angiography showed a primitive trigeminal artery (PTA) run between the cavernous segment of the internal carotid artery and the distal portion of the basilar artery. On initiation of PTA of R-ICA a small wide-necked saccular aneurysm was incidentally visualized. The aneurysm was successfully embolized after angiography using 2 Stent (Neuroform, 4.5mmm × 20mmm)-assisted detachable coils (Matrix), the ICA and PTA were preserved, and the patient was cured finally.

  3. Simultaneous posterior communicating artery aneurysm clipping and selective amygdalohippocampectomy via direct lateral access through the mesial temporal lobe to the basal cisterns.

    Science.gov (United States)

    Abla, Adib A; Smith, Kris A; Nakaji, Peter

    2011-05-01

    We report a 23-year-old man with intractable epilepsy and an incidental posterior communicating artery aneurysm who was treated simultaneously for both pathologies. He was counseled regarding the potential to treat both pathologies with one procedure. He elected to undergo a simultaneous approach. The patient was doing well at his 5-month follow-up examination with no residual seizures or neurologic deficits. We conclude that access to aneurysms within the basal cisterns is viable with transchoroidal approaches through the temporal horn of the lateral ventricle. Anterior extension through portions of the amygdala further increases access. In our patient, selective amygdalohippocampectomy and posterior communicating artery aneurysm clipping were performed during the same surgical setting/approach. This directly lateral corridor allowed our young patient with an incidental aneurysm to undergo a less invasive combined operation rather than two separate procedures.

  4. 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

  5. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

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    Kuzmanović Ilija B.

    2004-01-01

    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

  6. Elongation and dilatation of the basilar artery in CT imaging; Wydluzenie i poszerzenie tetnicy podstawowej w obrazie KT

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    Lasek, W.; Burzynska-Makuch, M.; Pilecki, S.; Grzegorzewski, M.; Boron, Z. [Akademia Medyczna, Bydgoszcz (Poland)

    1994-12-31

    During two years 5 rare cases of elongation and dilatation of basilar artery were recognized in CT examination. In patients with cranial nerve deficits, cerebellar, brainstem and ponto-cerebellar angle signs artery megadolichobasilaris should be taken into account. CT examination is the sufficient method to see the diagnosis. (author). 15 refs, 3 tabs, 4 figs.

  7. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Science.gov (United States)

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

    2011-02-01

    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  8. Bilateral giant femoropopliteal artery aneurysms: a case report

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    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.

  9. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

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    Pitton, Michael B.; Dappa, Evelyn; Jungmann, Florian; Kloeckner, Roman; Schotten, Sebastian; Wirth, Gesine M.; Mildenberger, Peter; Kreitner, Karl-Friedrich; Oberholzer, Katja; Dueber, Christoph [University Hospital of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Mittler, Jens; Lang, Hauke [University Hospital of Mainz, Department of Abdominal, Visceral and Transplantation Surgery, Mainz (Germany)

    2015-07-15

    To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. (orig.)

  10. Effect on management mortality of a deliberate policy of early operation on supratentorial aneurysms.

    Science.gov (United States)

    Disney, L; Weir, B; Petruk, K

    1987-05-01

    Of 736 patients with intracranial aneurysms seen at the University of Alberta from 1968 to 1985, 437 were admitted on the day of or the day after subarachnoid hemorrhage (SAH) from a supratentorial aneurysm. Of these, 205 were managed from 1968 through 1977 and 232 were managed from 1978 through early 1985 after a policy of early aneurysm operation had been implemented. Postoperative and management mortality and morbidity rates were related to the grade of the patient at the time of admission and the time interval before operation. Overall management mortality (and postoperative mortality) rates for patients treated before 1978 were 47% (19%) for all grades, 17% (12%) for Grades 1 and 2, 51% (25%) for Grades 3 and 4, and 100% (100%) for Grade 5. Since 1978, mortality has been reduced to 38% (11%) for all grades, 10% (5%) for Grades 1 and 2, 39% (17%) for Grades 3 and 4, and 96% (60%) for Grade 5. Management mortality for patients operated on Day 0 to 3 was lower than for those operated later after SAH both before and after 1978. Postoperative mortality was lowered in all patients operated from 1978 to 1985 regardless of the interval from SAH to operation, and management mortality was reduced overall, as well as for patients operated on day 0 to 3, in those treated from 1978 to 1985. The authors conclude that a policy of early aneurysm operation has contributed to a reduction of both postoperative and management mortality.

  11. EXPERIENCE OF MINIMALLY INVASIVE TREATMENT IN 520 PATIENTS WITH INTRACRANIAL ANEURYSMS

    Institute of Scientific and Technical Information of China (English)

    丁育基; 李慎茂; 段安安; 于小千; 华杨; 柳江; 王建生; 曹家康; 赵瑞林; 徐庚; 谷春; 王仲朴

    2002-01-01

    Objective.To summarize the experience of minimally invasive treatment in 520 patients with intracranial aneurysms on a retrospective study.Methods.The measures used in the treatment of 520 patients were reviewed in terms of timing of surgery,induced hypotensive anesthesia,brain protection combined with temporal occlusion of the feeding artery,external drainage of CSF,dynamic monitoring of intracranial pressure,blood flow velocity,serum osmolality and CT scanning,anti vasospasm therapy as well as selected interventional endovascular embolization of aneurysms.Results.Of the 520 patients,485 were treated with either direct clipping or endovascular embolization and 35 patients were treated non surgically.In 449 patients undergoing direct clipping and 36 undergoing endovascular embolization,intraoperative rupture of aneurysm occurred in 27 (6.0%) and 0%,respectively.Death occurred in 13 (2.6%),hemiplegia in 8 (1.6%),and vegetative state in 2 (0.4%).The operative mortality of direct clipping was 3.8% in 210 patients before 1990 and 1.8% in 275 patients after 1990 (36 patients undergoing endovascular embolization,the operative mortality was 0%).Conclusion.The outcome of patients with intracranial aneurysms can be markedly improved and the operative mortality can be lowered by minimally invasive treatment.

  12. An automatic CFD-based flow diverter optimization principle for patient-specific intracranial aneurysms.

    Science.gov (United States)

    Janiga, Gábor; Daróczy, László; Berg, Philipp; Thévenin, Dominique; Skalej, Martin; Beuing, Oliver

    2015-11-01

    The optimal treatment of intracranial aneurysms using flow diverting devices is a fundamental issue for neuroradiologists as well as neurosurgeons. Due to highly irregular manifold aneurysm shapes and locations, the choice of the stent and the patient-specific deployment strategy can be a very difficult decision. To support the therapy planning, a new method is introduced that combines a three-dimensional CFD-based optimization with a realistic deployment of a virtual flow diverting stent for a given aneurysm. To demonstrate the feasibility of this method, it was applied to a patient-specific intracranial giant aneurysm that was successfully treated using a commercial flow diverter. Eight treatment scenarios with different local compressions were considered in a fully automated simulation loop. The impact on the corresponding blood flow behavior was evaluated qualitatively as well as quantitatively, and the optimal configuration for this specific case was identified. The virtual deployment of an uncompressed flow diverter reduced the inflow into the aneurysm by 24.4% compared to the untreated case. Depending on the positioning of the local stent compression below the ostium, blood flow reduction could vary between 27.3% and 33.4%. Therefore, a broad range of potential treatment outcomes was identified, illustrating the variability of a given flow diverter deployment in general. This method represents a proof of concept to automatically identify the optimal treatment for a patient in a virtual study under certain assumptions. Hence, it contributes to the improvement of virtual stenting for intracranial aneurysms and can support physicians during therapy planning in the future.

  13. Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report

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    Tilea Ioan

    2012-08-01

    Full Text Available Abstract Introduction Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by Dacron patch plasty during adulthood. The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous stent-graft implantation avoids the need for surgical reintervention. Case presentation We report a case involving the hybrid treatment by stent-graft implantation and transposition of the left subclavian artery to the left common carotid artery of an aneurysmal dilatation of the thoracic aorta that occurred in a 64-year-old Caucasian man, operated on almost 40 years earlier with a Dacron patch plasty for aortic coarctation. Our patient presented to our facility for evaluation with back pain and shortness of breath after minimal physical effort. A physical examination revealed stony dullness to percussion of the left posterior thorax, with no other abnormalities. The results of chest radiography, followed by contrast-enhanced computed tomography and aortography, led to a diagnosis of giant aortic thoracic aneurysm. Successful treatment of the aneurysm was achieved by percutaneous stent-graft implantation combined with transposition of the left subclavian artery to the left common carotid artery. His post-procedural recovery was uneventful. Three months after the procedure, computed tomography showed complete thrombosis of the excluded aneurysm, without any clinical signs of left lower limb ischemia or new onset neurological abnormalities. Conclusions Our patient’s case illustrates the clinical outcomes of surgical interventions for aortic coarctation. However, the very late appearance of a local aneurysm is rather unusual. Management of such cases is always difficult. The decision-making should be multidisciplinary. A hybrid approach was considered the best solution for our patient.

  14. 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.)

  15. 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.

  16. Ruptured venous aneurysm of cervicomedullary junction

    Directory of Open Access Journals (Sweden)

    Ashish Aggarwal

    2014-01-01

    Full Text Available Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM or developmental venous anomaly (DVA. However, isolated venous aneurysm is unusual. Case Description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH and intraventricular hemorrhage (IVH. Digital substraction angiography (DSA revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ. Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 Χ 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein. Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.

  17. 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...

  18. External jugular venous aneurysm: A clinical curiosity

    Science.gov (United States)

    Mohanty, Debajyoti; Jain, Bhupendra Kumar; Garg, Pankaj Kumar; Tandon, Anupama

    2013-01-01

    Jugular venous aneurysm is an extremely rare condition. The patients presented with a painless swelling in the neck that appears while coughing, straining, bending, or breath holding. Detection of a soft and compressible swelling in the course of an external jugular vein (EJV) superficial to the sternomastoid muscle, non-filling on compression of the EJV during Valsalva maneuver clinches the diagnosis of EJV aneurysm. Color Doppler ultrasound allows precise delineation of the lesion and is considered the gold standard for confirming the diagnosis. Surgical excision is indicated mostly for cosmetic reasons and symptomatic aneurysms. We, herein, report a patient with saccular external jugular venous aneurysm to highlight the typical clinical presentation and diagnosis of this rare entity. PMID:23633867

  19. Natural history of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Schroeder, T V; Olsen, P S

    1993-01-01

    During a 10-year period in which 735 patients presented with abdominal aortic aneurysms to our clinic, 63 were not offered operative treatment. The primary reason for choosing conservative treatment was concomitant diseases that increased the risk of operation. After 2 years of followup, half...... of the patients died, and the cumulative 5-year survival rate was 15%. Aneurysm rupture was the primary cause of death. The cumulative 5-year mortality hazard rate from rupture was 0.36, corresponding to an annual risk of rupture of 7%. The cumulative 5-year hazard rate of death from all other causes was 1.......53, corresponding to an annual risk of 30%. Diameter of the aneurysm was found to be the only factor with a significant impact on the rate of rupture. The cumulative 5-year hazard rate of rupture among patients with aneurysms or = 6 cm was 0.2 and 0.6, respectively, corresponding to an annual risk...

  20. Endovascular treatment of wide-necked intracranial aneurysms using of "remodeling technique" with the HyperForm balloon

    Institute of Scientific and Technical Information of China (English)

    MU Shi-qing; YANG Xin-jian; LI You-xiang; ZHANG You-ping; L(U) Ming; WU Zhong-xue

    2008-01-01

    Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. Methods From June 2004 to September 2006, forty-two patients(20 men, 22 women)with wide-necked or large neck/fundus ratio aneurysms were treated by using the"remodeling technique"with the HyperForm balloon. Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases(80.9%), subtotal in 4 (9.5%) and incomplete in 2(4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. Conclusions The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.

  1. Aneurysmal portosystemic venous shunt: a case report.

    Science.gov (United States)

    Bodner, G; Glück, A; Springer, P; König, P; Perkmann, R

    1999-10-01

    A case of an aneurysmal portosystemic venous shunt detected by colour Doppler ultrasound (CDUS) is presented. A young female patient complained of postprandial fatigue and had paroxysmal tachycardia. A direct vascular communication between right portal vein and right hepatic vein was found at CDUS and confirmed by direct portal angiogram. Using detachable coils a complete occlusion of the intrahepatic shunt was obtained. Reports from the literature regarding portovenous aneurysms are reviewed.

  2. Multiple tuberculous aneurysms of the aorta.

    Science.gov (United States)

    Pierret, Charles; Tourtier, Jean-Pierre; Grand, Bertrand; Boddaert, Guillaume; Laurian, Claude; de Kerangal, Xavier

    2011-06-01

    Tuberculous aneurysms of the aorta are quite rare, but are exceptional when found in multiple locations. We report the case of multiple tuberculous aortic aneurysms of the thoracic and abdominal aorta in a 19-year-old female discovered when she consulted for thrombocytopenic purpura. The treatment for both locations included prolonged antituberculous therapy and surgical resection with cryopreserved aortic allograft patch for the reconstruction.

  3. Intracranial aneurysms in an African country

    Directory of Open Access Journals (Sweden)

    Ogeng'o Julius

    2009-12-01

    Full Text Available Background : Characteristics of intracranial aneurysms display ethnic variations. Data on this disease from the African continent is scarce and often conflicting. Aim : To describe site, age and gender distribution of intracranial aneurysms among Kenyans. Study Design and Setting : Retrospective study at Kenyatta National Hospital, Kenya. Materials and Methods: All records of black African patients with a diagnosis of intracranial aneurysms seen at Kenyatta National Hospital, the largest referral hospital in the Eastern and Central African region, over the period from January 1998 to December 2007 were examined for site, age and gender distribution. The data gathered were coded, analyzed with SPSS 11.50. Results : Fifty-six cases of intracranial aneurysms were analyzed. The posterior communicating artery was the most affected (35.7%, followed by the anterior communicating artery (26.8%, while the posterior cerebral artery was the least affected (2%. Multiple aneurysms were present in 2%. The mean age at presentation was 50.9 years (range 21-80 years and the gender distribution was equal. Conclusions : Intracranial aneurysms among Kenyans occur most commonly on the posterior communicating artery, in young individuals, and without gender bias. The distribution differs from that described in the literature and this requires search for risk factors.

  4. Maximal aneurysm diameter follow-up is inadequate after endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Wever, JJ; Blankensteijn, JD; Mali, WPTM; Eikelboom, BC

    2000-01-01

    Background: follow-up after endovascular abdominal aortic aneurysm repair (EAR) generally consists of serial diameter measurements. A size change after EAR, however, is the consequence of alterations of the excluded aneurysm sac volume. Objective: to assess the agreement between diameter measurement

  5. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Su, I-Chang

    2014-06-01

    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.

  6. 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 Neth

  7. Modeling two-tone suppression and distortion product on basilar membrane

    Science.gov (United States)

    Murakami, Yasuki; Ishimitsu, Shunsuke

    2015-12-01

    This paper reveals mechanisms of two-tone suppression (2TS) and distortion product (DP) on the basilar membrane (BM) using a model. Computational simulation is conducted with an active and nonlinear transmission line model including a nonlinear outer hair cell model that shows compressive property in two dimensionally where two tones are input. To evaluate the cochlear model, over all responses of BM model are used. For simultaneous input pairs, the response is suppressed by a stronger tone, or distorted where levels of a pair are equaled. Cubic distortion produced by a simple nonlinear feedback system including the OHC model appears similar to DPs in the cochlear model. These results suggest that two dimensional property of the OHC and its feedback generate 2TS and DPs. This further suggests the importance of the overall responses for investigating mechanisms of cochlear nonlinearities without fluid coupling in the cochlea.

  8. Behavioral estimates of basilar-membrane input-output in normal-hearing listeners

    DEFF Research Database (Denmark)

    Jepsen, Morten Løve; Dau, Torsten

    2011-01-01

    To characterize human cochlear processing it would be beneficial to behaviorally estimate the basilar membrane (BM) input-output (I/O) function. In recent studies, forward masking has been used to estimate BM compression. In this study, a growth-of-forward-masking (GOM) paradigm (e.g., Oxenham...... function is expected than that obtained for a high-level signal where both masker and signal are processed compressively. The knee point can be estimated at the input level where the GOM slope changes significantly. Data were collected from seven normal - hearing listeners. The method was found to provide...... estimates of the BM I/O function for a wider range of input levels than in previously suggested methods, due to the additional estimates of the knee points....

  9. From bench to bedside: utility of the rabbit elastase aneurysm model in preclinical studies of intracranial aneurysm treatment.

    Science.gov (United States)

    Brinjikji, Waleed; Ding, Yong H; Kallmes, David F; Kadirvel, Ramanathan

    2016-05-01

    Preclinical studies are important in helping practitioners and device developers improve techniques and tools for endovascular treatment of intracranial aneurysms. Thus an understanding of the major animal models used in such studies is important. The New Zealand rabbit elastase induced arterial aneurysm of the common carotid artery is one of the most commonly used models in testing the safety and efficacy of new endovascular devices. In this review we discuss: (1) the various techniques used to create the aneurysm, (2) complications of aneurysm creation, (3) natural history of the arterial aneurysm, (4) histopathologic and hemodynamic features of the aneurysm, (5) devices tested using this model, and (6) weaknesses of the model. We demonstrate how preclinical studies using this model are applied in the treatment of intracranial aneurysms in humans. The model has similar hemodynamic, morphological, and histologic characteristics to human aneurysms, and demonstrates similar healing responses to coiling as human aneurysms. Despite these strengths, however, the model does have many weaknesses, including the fact that the model does not emulate the complex inflammatory processes affecting growing and ruptured aneurysms. Furthermore, the extracranial location of the model affects its ability to be used in preclinical safety assessments of new devices. We conclude that the rabbit elastase model has characteristics that make it a simple and effective model for preclinical studies on the endovascular treatment of intracranial aneurysms, but further work is needed to develop aneurysm models that simulate the histopathologic and morphologic characteristics of growing and ruptured aneurysms.

  10. Analysis and Comparison of 2-D Hemodynamic Numerical Simulation of Elastic Aneurysm and Rigid Aneurysm

    Science.gov (United States)

    Zhao, J. W.; Ding, G. H.; Yin, W. Y.; Yang, X. J.; Shi, W. C.; Zhang, X. L.

    The objective of this study is to investigate the effect of hemodynamic parameters on the formation, growth and rupture of an aneurysm. Our simulation of the elastic and rigid aneurysm is based on a DSA or other clinic image. The simulatied results are that there are great differences in the distribution of velocity magnitude at some sections which are predicted by the two models. For the elastic wall model, the distribution of velocity magnitude of one outlet is obviously off-center, which influences the distribution of wall shear stress (WSS) and exchange of substance through the vessel wall. The currents of the distributions of WSS along the wall of aneurysm for the two models are similar. But there are obvious differences between the two models in the values especially at the neck of aneurysm. This study demonstrates obviously that the elastic wall model suits the simulation for growth and rupture of an aneurysm better.

  11. Flow Instability and Wall Shear Stress Ocillation in Intracranial Aneurysms

    Science.gov (United States)

    Baek, Hyoungsu; Jayamaran, Mahesh; Richardson, Peter; Karniadakis, George

    2009-11-01

    We investigate the flow dynamics and oscillatory behavior of wall shear stress (WSS) vectors in intracranial aneurysms using high-order spectral/hp simulations. We analyze four patient- specific internal carotid arteries laden with aneurysms of different characteristics : a wide-necked saccular aneurysm, a hemisphere-shaped aneurysm, a narrower-necked saccular aneurysm, and a case with two adjacent saccular aneurysms. Simulations show that the pulsatile flow in aneurysms may be subject to a hydrodynamic instability during the decelerating systolic phase resulting in a high-frequency oscillation in the range of 30-50 Hz. When the aneurysmal flow becomes unstable, both the magnitude and the directions of WSS vectors fluctuate. In particular, the WSS vectors around the flow impingement region exhibit significant spatial and temporal changes in direction as well as in magnitude.

  12. Renal failure after operation for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Perko, M

    1990-01-01

    Among 656 patients undergoing surgery for abdominal aortic aneurysm, 81 patients (12%) developed postoperative renal failure. Before operation hypotension and shock occurred in 88% of the patients with ruptured aneurysm, whereas none of the patients operated electively were hypotensive. Dialysis...

  13. Modification of an endovascular stent graft for abdominal aortic aneurysm

    Science.gov (United States)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  14. Thoracic aortic aneurysm: reading the enemy's playbook.

    Science.gov (United States)

    Elefteriades, John A

    2008-05-01

    The vast database of the Yale Center for Thoracic Aortic Disease--which includes information on 3000 patients with thoracic aortic aneurysm or dissection, with 9000 catalogued images and 9000 patient-years of follow-up--has, over the last decade, permitted multiple glimpses into the "playbook" of this virulent disease. Understanding the precise behavioral features of thoracic aortic aneurysm and dissection permits us more effectively to combat this disease. In this monograph, we will first review certain fundamentals--in terms of anatomy, nomenclature, imaging, diagnosis, medical, surgical, and stent treatment. After reviewing these fundamentals, we will proceed with a detailed exploration of lessons learned by peering into the operational playbook of thoracic aortic aneurysm and dissection. Among the glimpses afforded in the behavioral playbook of this disease are the following: 1 Thoracic aortic aneurysm, while lethal, is indolent. Mortality usually does not occur until after years of growth. 2 The aneurysmal ascending thoracic aorta grows slowly: about 0.1 cm per year (the descending aorta grows somewhat faster). 3 Over a patient's lifetime, "hinge points" at which the likelihood of rupture or dissection skyrockets are seen at 5.5 cm for the ascending and 6.5 cm for the descending aorta. Intervening at 5 cm diameter for the ascending and 6 cm for the descending prevents most adverse events. 4 Symptomatic aneurysms require resection regardless of size. 5 The yearly rate of rupture, dissection, or death is 14.1% for a patient with a thoracic aorta of 6 cm diameter. 6 The mechanical properties of the aorta deteriorate markedly at 6 cm diameter (distensibility falls, and wall stress rises)--a finding that "dovetails" perfectly with observations of the clinical behavior of the thoracic aorta. 7 Thoracic aortic aneurysm and dissection are largely inherited diseases, with a predominantly autosomal-dominant pattern. The specific genetics are being elucidated at the

  15. Wall shear stress in intracranial aneurysms and adjacent arteries

    Institute of Scientific and Technical Information of China (English)

    Fuyu Wang; Bainan Xu; Zhenghui Sun; Chen Wu; Xiaojun Zhang

    2013-01-01

    Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries.

  16. Traumatic aneurysms of the intracranial and cervical vessels: A review

    Directory of Open Access Journals (Sweden)

    Kamlesh S Bhaisora

    2016-01-01

    Full Text Available Traumatic intracranial aneurysms (TICA are rare in occurrence, constituting less than 1% of the total cases of intracranial aneurysms. Cervical posttraumatic aneurysms arising from major blood vessels supplying the brain are also extremely rare. Their variable locations, morphological variations and the presence of concomitant head injury makes their diagnosis and treatment a challenge. In this review, we discuss the epidemiology, etiology, classification and management issues related to TICA as well as traumatic neck aneurysms and review the pertinent literature.

  17. Distal posterior inferior cerebellar artery aneurysm in a child

    Directory of Open Access Journals (Sweden)

    J. Francisco Salomão

    1992-06-01

    Full Text Available The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA, successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  18. Epidemiology and genetics of intracranial aneurysms.

    Science.gov (United States)

    Caranci, F; Briganti, F; Cirillo, L; Leonardi, M; Muto, M

    2013-10-01

    Intracranial aneurysms are acquired lesions (5-10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3-p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3-p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2 gene

  19. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  20. Operative strategy of complex internal carotid artery-posterior communicating artery aneurysms Defensive effect on perioperative nerve injury

    Institute of Scientific and Technical Information of China (English)

    Xinmin Wang; Wende Xiong; Xuqin Li

    2007-01-01

    BACKGROUND: The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA)aneurysms.OBJECTIVE: To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms, and investigate how to better protect the brain tissue.DESIGN: A retrospective case analysis.SETTING: Department ofNeurosurgery, Dalian Central Hospital.PARTICIPANTS: Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%)of complex ICA-PComA aneurysms, 8 males and 11 females, 38 - 67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS: The clinical manifestations, including initial symptoms and Hunt&Hess grading, were observed. Corresponding strategies were selected for different types of ICA-PComA aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4 - 5 points), bad (2 - 3 points) and dead (1 point). The results at discharge were taken as early results, whereas the follow-up results as late results.MAIN OUTCOME MEASURES: Clinical manifestations and curative effects of the patients.RESULTS: All the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations, the initial symptoms were subarachnoid hemorrhage (n =15), paralysis of oculomotor nerve (n =3), and occasional attack (n =1); The Hunt&Hess grading was grade Ⅰ in 4 cases, grade Ⅱ in 6 cases,grade Ⅲ in 6 cases, grade Ⅳ in 2 cases, and grade Ⅴ in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case. The