Journal of neurointerventional surgery
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Idiopathic intracranial hypertension (IIH) is characterized by headache, papilledema, visual field changes and tinnitus with elevated cerebral spinal fluid opening pressures on lumbar puncture. Left untreated, this condition can lead to permanent visual loss. Previous treatment modalities include medical management, therapeutic lumbar puncture and optic nerve sheath fenestration. ⋯ There was a technical success rate of 99% for the stent placement procedure with a total of nine complications (6%). At follow-up (mean 22.3 months), 88% of patients experienced improvement in headache, 97% demonstrated improvement or resolution of papilledema, 87% experienced improvement or resolution of visual symptoms and 93% had resolution of pulsatile tinnitus. In patients with IIH with focal venous sinus stenosis, endovascular stent placement across the stenotic sinus region represents an effective treatment strategy with a high technical success rate and decreased rate of complications compared with treatment modalities currently used.
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To report two cases of a rare cause of subarachnoid hemorrhage (SAH), including unusual presentation and an emerging and effective treatment option. ⋯ Rupture of aneurysms arising from basilar artery perforators is a rare cause of SAH and attention to this area should be part of an interventionist's search pattern. Aneurysms in this area may not be apparent in the immediate post rupture setting and delayed post hemorrhage angiography has a role in detecting this entity. Stent monotherapy may be effective in treating these lesions.
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Endovascular treatment of vertebral artery (VA) origin stenosis typically requires placement of the proximal end of the stent within the lumen of the subclavian artery or aorta to provide complete coverage of the ostial lesion. This configuration may complicate subsequent endovascular access into the stented VA. We describe a technique modification of VA origin stenting and angioplasty with a monorail angioplasty balloon system designed specifically for dilation of the ostial origin which may be helpful in conforming the proximal portion of the stent to the VA origin. Simplified endovascular access to the VA origin after angioplasty is demonstrated.
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Although most neurovascular diseases can be treated either by microsurgical or endovascular means, a subset of patients may require a combined approach. Patient transfer from the operating room (OR) to the angiosuite has been a fundamental drawback of this type of approach. ⋯ A combined endovascular and surgical approach conducted in a hybrid OR provides a new strategy for the treatment of complex neurovascular diseases.