Journal of neurointerventional surgery
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Case Reports
Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient.
A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. ⋯ The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension.
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A 54-year-old man presented with recurrent episodes of transient ischemic attacks and acute stroke secondary to a floating thrombus in the right vertebral artery (VA) with narrowing of the right VA. He was initially treated medically with anticoagulation, antiplatelets and statins but developed multiple fresh infarcts. He was then referred for endovascular treatment, which was performed in a novel way.
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The use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the past 5 years, with few available data. The aim of this study was to analyze the cost and benefit of mechanical thrombectomy devices utilized during endovascular therapy of ischemic stroke patients. ⋯ For the treatment of acute stroke patients, the use of aspiration appears to be the most cost effective method to achieve acceptable recanalization rates and low complication rates. Stent retriever with local aspiration, despite higher costs and complication rates, yielded better overall outcome.
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Comparative Study
Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping.
Stent-assisted coiling (SAC) of unruptured intracranial aneurysms is a treatment alternative to clipping or coiling, although high complication and procedure-related mortality rates have been reported. ⋯ SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.
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Case Reports
Occlusion of a clival dural arteriovenous fistula using a novel approach through the foramen ovale.
Dural arteriovenous fistulas (DAVFs) are abnormal connections between arteries and veins that are classified by location, morphology or direction of venous drainage. Treatment of DAVFs is undertaken in patients with severe symptoms or those with retrograde cortical venous drainage and/or venous ectasia. ⋯ Specialised software was used to create a safe trajectory to the DAVF via the foramen ovale. The patient then underwent successful occlusion of the clival DAVF, thus further increasing the neurointerventionalist's armamentarium when attempting to treat difficult to reach clival DAVFs.