Journal of neurointerventional surgery
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Flow diversion is a promising technique for cerebral aneurysm treatment but presents new and sometimes unique challenges. Transient reversible narrowing due to device reconfiguration of the pipeline embolization device (PED) has not been previously described. Here we describe a patient with dolichoectasia of the distal right internal carotid artery with an associated saccular sidewall aneurysm who developed asymptomatic circumferential narrowing of the proximal aspect of the PED in the first month following deployment. The patient was followed conservatively and demonstrated partial resolution of device narrowing on 6 month follow-up imaging.
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Anterior circulation perforating artery aneurysms including anterior choroidal artery and lenticulostriate artery aneurysms are rare. Injury to these vessels can lead to severe debilitating symptoms. ⋯ Our preliminary results show that flow diversion technology is an effective and safe therapy for complex, hard-to-treat aneurysms in perforating arteries. Larger studies with long-term follow-up are needed to validate our promising results.
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Case Reports
External carotid stenting for symptomatic stenosis in a patient with patent EDAS for Moyamoya disease.
Moyamoya disease is characterized by progressive narrowing of the internal carotid artery (ICA). Symptomatic patients typically undergo cerebrovascular intervention via extracranial-intracranial (EC-IC) bypass, most often with the use of the superficial temporal artery. This case of Moyamoya disease is of particular interest as the patient presented with a unilateral atherosclerotic external carotid artery (ECA) stenosis after EC-IC bypass that eliminated the benefit of his original surgery, resulting in a symptomatic presentation. ⋯ This case illustrates that a patient presenting with Moyamoya disease and concurrent symptomatic ECA stenosis post-EDAS can be effectively and safely treated with ECA stenting.
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Comparative Study
Balloon-augmented Onyx endovascular ligation: initial human experience and comparison with coil ligation.
Carotid artery sacrifice remains an important procedure for cerebral vascular disorders despite the development of new endovascular devices. Conventional carotid artery sacrifice with detachable coils alone often requires numerous coils to complete occlusion. ⋯ Balloon-augmented Onyx endovascular ligation may reduce costs and fluoroscopy times during vessel sacrifice. Further studies in a larger number of patients are needed to confirm these findings.
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The Apollo system (Penumbra Inc, Alameda, California, USA) is a low profile irrigation-aspiration system designed for the evacuation of intracranial hemorrhage. ⋯ The cadaver model described is a useful means of studying interventional techniques for intracranial hemorrhage. It seems feasible to use CB-CT to guide the evacuation of intraparenchymal and intraventricular hemorrhage using the Apollo system through a minimally invasive transcranial access.