Interv Neuroradiol
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Case Reports
Unexpected occlusion of the contralateral transverse sinus after stenting for idiopathic intracranial hypertension.
A woman in her thirties with intracranial hypertension underwent stenting of the right transverse-sigmoid (TS) junction with resolution of the pressure gradient. Due to persisting symptoms at follow-up, she underwent a repeat study showing a patent right TS stent but the non-dominant left transverse sinus, patent on initial studies, was now completely occluded. According to the positive feedback loop hypothesis, stenting of the right transverse sinus should have resulted in a reduction in intracranial pressures (confirmed by post-stenting lumbar puncture), but also an increase in left transverse sinus diameter, opposed to the occlusion seen on venography. This unexpected finding can be explained by the positive feedback loop hypothesis if a revision is made accounting for intramural venous pressures as an opposing force of venous sinus stenosis, as venous outflow obstruction in the dominant venous sinus pathway provided an increased intramural venous pressure in the non-dominant sinus facilitating patency against extramural pressures.
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Mechanical thrombectomy is a safe and effective treatment in patients with acute ischemic stroke caused by large vessel occlusions. However, in rare cases, the procedure may be challenging due to the composition of the embolus. We describe a case of a mechanical thrombectomy with the Embolus Retriever with Interlinked Cage (ERIC) device in a patient with an acute ischemic stroke due to calcified cerebral emboli in the middle cerebral artery. ⋯ After the administration of an intravenous thrombolytic agent, the patient was transferred to the angiographic suite for a mechanical thrombectomy. After failure to recanalize the vessel with manual aspiration thrombectomy, successful recanalization was achieved via mechanical thrombectomy using the ERIC device. Mechanical thrombectomy with an ERIC device can be a useful option in cases of acute ischemic stroke caused by calcified cerebral emboli.
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Observational Study
The Woven EndoBridge (WEB) as primary treatment for unruptured intracranial aneurysms.
Purpose The intrasaccular flow disruptor Woven EndoBridge (WEB) device is developed for the treatment of wide-necked aneurysms without supportive devices. We used the WEB as primary treatment for unruptured aneurysms suitable for the device, regardless of neck size. Methods Between February 2015 and June 2017, 59 aneurysms in 51 patients were selectively treated with the WEB. ⋯ There was no need for supportive devices. Three-quarters of all unruptured small aneurysms could be treated with the WEB. In our opinion, the WEB is a valuable alternative to coils, especially in wide-necked aneurysms.
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Review Case Reports
Successful thrombectomy in endocarditis-related stroke: Case report and review of the literature.
Neurological complications of infective endocarditis are frequent, especially ischaemic strokes. As intravenous thrombolysis in infective endocarditis-related ischaemic stroke has a controversial benefit/risk ratio, alternative treatment regimens have to be considered. We present the case of a young patient with septic embolism of the middle cerebral artery who was successfully treated with mechanical thrombectomy, and give a short review of the existing literature.
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Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. ⋯ Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes.