Journal of neurointerventional surgery
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Moyamoya disease (MMD) is a rare cerebrovascular disease usually characterized by progressive bilateral distal internal carotid artery stenosis or occlusion and its consequences. Direct (ie, extracranial-intracranial bypass) or indirect cerebral revascularization procedures are the most established and effective treatment strategies for MMD. The case history is presented of a patient with MMD with delayed severe intracranial and subarachnoid hemorrhage following intracranial carotid artery stent placement. ⋯ This case report illustrates a severe intracerebral and subarachnoid hemorrhage following intracranial stenting of the internal carotid artery in a young patient with MMD. Potentially this complication could be attributed to high perfusion pressure breakthrough phenomenon, a known complication after cerebral high-flow bypass surgery. The role of intracranial stenting, despite established revascularization procedures in patients with MMD, therefore remains highly questionable.
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Case Reports
Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two cases.
Flow-diverting stents have demonstrated great promise for the treatment of cerebral aneurysms; however, clinical experience with the devices remains very preliminary. We present two cases of spontaneous delayed complications-one fatal aneurysm rupture and one symptomatic increase in aneurysm volume-following the treatment of intradural aneurysms with the Pipeline Embolization Device (PED). ⋯ Flow-diverting devices have demonstrated tremendous promise for the treatment of complex, unruptured cerebral aneurysms. However, experience with this novel approach to aneurysm treatment is preliminary and the consequences of its application within the cerebrovasculature remain incompletely defined. Mural destabilization resulting in delayed, spontaneous, aneurysm growth and/or rupture may occur in the days to weeks following the application of flow-diverting devices to treat previously unruptured intracranial aneurysms. A better understanding of the incidence and etiology of these complications is essential for this technology to be optimally applied.
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To evaluate the rate of peri-procedural thromboembolic events after the endovascular treatment of cerebral aneurysms. The rate of diffusion-positive lesions was assessed in relation to selected procedural and technical factors. ⋯ In this study, peri-procedural DWI-positive lesions occurred in approximately one-third of all cases. These were threefold more common in the setting of ruptured aneurysms. Adjunctive devices did not increase the rate of ischemic events. On the contrary, there was a trend toward fewer DWI abnormalities in the procedures in which balloon remodeling was employed. This may, in part, be related to the application of the conglomerate coil mass technique of balloon remodeling.
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To assess the long-term safety and clinical effectiveness of inferior vena cava (IVC) filters in patients with stroke. ⋯ IVC filters have an acceptable safety profile in stroke patients. In our cohort, they were effective in preventing life-threatening PE.
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'Artery of Percheron' is a rare variation in blood supply in which a solitary arterial trunk arises from one of the proximal segments of the posterior cerebral arteries and supplies the paramedian thalami bilaterally. A young patient (in their early 30s) who presented with sudden onset of visual disturbance and speech difficulties is reported. A review of literature from 1981 to 2009 and review of the most widely reported clinical signs and symptoms are provided.