scholarly journals Endovascular Treatment of Acute MI Occlusions Due To Underlying Intracranial Atherosclerotic Severe Stenosis

2021 ◽  
Author(s):  
Yazhou Yan ◽  
Li Du ◽  
Xiliang He ◽  
Qinghai Huang ◽  
Yuan Pan ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Angioplasty ◽  
Rescue Therapy ◽  
Perioperative Complications ◽  
Clinical Results ◽  
Severe Stenosis ◽  
Acute Occlusion ◽  
Hemorrhagic Event ◽  
Single Balloon

Abstract Objective: Endovascular treatment (EVT) for acute ischemic stroke with an occlusion of the M1 segment due to intracranial atherosclerotic severe stenosis (ICASS) remains challenging. This study aimed to evaluate the safety and efficacy of EVT for ICASS-related M1 acute occlusion.Methods: We retrospectively reviewed all patients with an ICASS-related M1 acute occlusion underwent EVT at our institution between January 2015 and December 2020. Clinical presentation, baseline characteristics, angiographic and clinical results, technical feasibility, perioperative complications, and follow-up results were evaluated.Results: Twenty-two patients with ICASS-related M1 acute occlusion were included. Eight patients (36.4%) received bridging therapy and the other 14 patients (63.6%) directly underwent EVT. Fifteen patients (68.2%) treated with balloon dilations and stenting as rescue treatment. Six patients (27.3%) received single balloon angioplasty and 5 of these patients treated with staged stenting. One case (4.5%) failed recanalization at the first EVT and successful revascularization was achieved a month later. The mean procedure time was 67.2±20.8 min. Successful revascularization (mTICI≥2b) was achieved in 95.5% (21/22) of patients. Perioperative complications developed in two patients (9.1%) including one hemorrhagic event and one thromboembolic event. Anangiographic follow-up was available in 20 patients (90.9%) at an average of 8.6±3.0 months. The degree of stenosis was worse (10%-30%) in 6 cases (30%) compared with the initial outcomes. The favorable outcomes (mRS≤2) at 3 months follow-up was achieved in 19 patients (86.4%).Conclusions: ICASS-related occlusion in the M1 segment often required a rescue therapy including balloon angioplasty with/without stenting, and this treatment strategy was safe and effective. But single balloon angioplasty at the first EVT generally cannot achieve satisfactory results and often needed staged stenting treatment.

scholarly journals The use of single low-profile visualized intraluminal support stent-assisted coiling in the treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysm

2020 ◽  
Vol 26 (4) ◽  
pp. 461-467 ◽  
Author(s):  
Yazhou Yan ◽  
Zhangwei Zeng ◽  
Yina Wu ◽  
Jiachao Xiong ◽  
Kaijun Zhao ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Thromboembolic Event ◽  
Perioperative Complications ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Hemorrhagic Event ◽  
Low Profile

Objective Endovascular treatment of unruptured wide-necked aneurysms located at the middle cerebral artery bifurcation remains challenging. This study aimed to evaluate the safety and efficacy of endovascular treatment for middle cerebral artery bifurcation unruptured wide-necked aneurysms using a low-profile visualized intraluminal support (LVIS) stent. Methods We retrospectively reviewed all patients with middle cerebral artery bifurcation unruptured wide-necked aneurysms treated using an LVIS device at our institution between October 2014 and December 2018. Clinical presentation, aneurysmal characteristics, technical feasibility, perioperative complications, clinical outcome, and angiographic and clinical follow-up results were evaluated. Results Fifty-seven patients with 57 wide-necked aneurysms arising from the middle cerebral artery bifurcation were identified. The technical success rate of stent deployment was 100%. Immediate postoperative angiograms showed Raymond 1 in 26 aneurysms (45.6%), Raymond 2 in 10 (17.6%), and Raymond 3 in 21 (36.8%). Perioperative complications developed in two patients (3.5%), including one procedure-related hemorrhagic event and one thromboembolic event. The follow-up angiogram was available for 47 aneurysms obtained at an average of 11.7 months (range, 5 to 49 months) after intervention; the latest follow-up angiograms revealed complete occlusion in 37 (78.7%) aneurysms, improvement in three (6.4%), stabilization in five (10.6%), and recanalization in two (4.3%). During the follow-up, one patient was found to have in-stent stenosis and two patients were found to have slow flow or occlusion of the jailed branch. All three of these patients were asymptomatic. No hemorrhagic or thromboembolic events occurred during clinical follow-up. Conclusions Our experience suggests that endovascular treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysms with an LVIS stent is safe and effective, but the effect on branches needs to be further studied.

Abstract TP3: Early Reocclusion After Mechanical Thrombectomy for Acute Stroke Due to Intracranial Atherosclerotic Stenosis-Related Occlusions

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Masatomo Miura ◽  
Yoichiro Nagao ◽  
Makoto Nakajima ◽  
Seigo Shindo ◽  
Kuniyasu Wada ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Balloon Angioplasty ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Multivariable Logistic Regression Analysis ◽  
Intracranial Stenting ◽  
Atherosclerotic Stenosis

Background: In acute ischemic stroke (AIS) patients due to intracranial atherosclerosis-related occlusions (ICAS-O), despite successful reperfusion with mechanical thrombectomy (MT), unexpected early reocclusion sometimes occurs and worsens clinical outcome. We investigated prevalence, outcomes, and predictors of early reocclusion within 48 hours of MT in AIS due to ICAS-O. Methods: In 557 consecutive AIS patients who underwent MT from January, 2016 to March, 2019 in two stroke centers, 71 patients due to ICAS-O were retrospectively evaluated. We divided them into two groups: patients with early reocclusion and those without. Clinical and angiographical findings and outcomes were compared between the 2 groups. Multivariable logistic regression analysis was used to investigate predictors of early reocclusion after MT. Results: Of 71 patients (aged 72 ± 10 years; 23 women; median NIHSS score, 15), early reocclusion was observed in 11 (15%). The first procedure for recanalization was stent retriever in 25 patients (35%), Penumbra system in 25 patients (35%), and balloon angioplasty in 21 patients (30%). Of these, 63 patients (88%) received rescue therapy (balloon angioplasty, 50; intracranial stenting, 13). In the early reocclusion group, more number of intraprocedural reocclusion (median [IQR], 3 [2-3] vs. 1 [0-1], p < 0.001), a higher rate of remaining stenosis on the final angiography (67.6 ± 5.9% vs 57.3 ± 15.9%, p = 0.044), and a higher rate of procedure-related adverse events (27% vs 5%, p = 0.043) were observed compared to the other group. On logistic regression analysis, a total number of intraprocedural reocclusion was independently associated with early reocclusion (odds ratio, 31.4; 95% confidence interval, 2.6-375.2). Early reocclusion was related to a low rate of favorable outcome at 90 days (modified Rankin Scale ≤ 2, 9% vs 54%, p = 0.007). Conclusions: In AIS patients due to ICAS-O, early reocclusion within 48 hours was not rare and associated with unfavorable outcome. Patients with repeated intraprocedural reocclusion are at high risk for early reocclusion; they might need follow-up angiographical assessment and intensive antithrombotic treatment.

Endovascular Treatment for Pseudo-occlusion of the Internal Carotid Artery

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 301-309 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Tomoyuki Tsumoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Perioperative Complications ◽  
Carotid Stenting ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Embolic Protection

Abstract OBJECTIVE: The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition. METHODS: Twenty cases of carotid pseudo-occlusion (17 symptomatic, three asymptomatic) were treated with carotid artery stenting. Nineteen patients were treated with various embolic protection techniques. Our clinical results, including angiographic follow-up data, perioperative complications, and data on the effectiveness of the embolic protection methods were studied for ICA pseudo-occlusion. RESULTS: All pseudo-occlusions were successfully dilated, and the stenotic ratio was reduced from 95 to 6.7% on average. No neurological deterioration was encountered in any of the cases, although one patient died of cardiac event 1 day after treatment. None of the patients experienced stroke during the mean 24.8 month follow-up period, although one patient died from myocardial infarction. Among the 17 cases in which follow-up angiography was performed at 6 months after stenting, only one patient demonstrated restenosis. This patient was successfully treated with repeated percutaneous transluminal angioplasty. The rate of restenosis in our series was 5.9%, and the morbidity/mortality rate within 30 days was 5%. CONCLUSION: The clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.

Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

1997 ◽  
Vol 86 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Jean Raymond ◽  
Daniel Roy ◽  
Michel Bojanowski ◽  
Robert Moumdjian ◽  
Georges L'Espérance
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Clinically Significant ◽  
Technical Complication ◽  
Fine Print

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

scholarly journals Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure

2011 ◽  
Vol 152 (43) ◽  
pp. 1745-1750 ◽  
Author(s):  
Tamás Mirkó Paukovits ◽  
Balázs Nemes ◽  
Kálmán Hüttl ◽  
Viktor Bérczi
Keyword(s):  
Endovascular Treatment ◽  
Upper Limb ◽  
Balloon Angioplasty ◽  
Stent Implantation ◽  
Neurological Complication ◽  
Innominate Artery ◽  
Safe Procedure ◽  
Duplex Scan ◽  
Excellent Outcome

Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective. Orv. Hetil., 2011, 152, 1745–1750.

scholarly journals Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms

2018 ◽  
Vol 76 (5) ◽  
pp. 332-338 ◽  
Author(s):  
Zeferino Demartini Junior ◽  
Luana A. Maranha Gatto ◽  
Gelson Luis Koppe ◽  
Tatiana F. von Hertwig de Oliveira ◽  
Alexandre Novicki Francisco
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Arterial Occlusion ◽  
Complete Recovery ◽  
Aneurysm Embolization ◽  
Stent Retrievers ◽  
Arterial Recanalization

ABSTRACT Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths. Five patients showed complete recovery (mRS 0) and all patients showed improvement of disability (average mRS 1.1) over a mean follow-up period of 31 months. Eight patients had good clinical recovery, while two remained with deficits (mRS 3 and 4). The study found that the stent retriever is a valuable, rapid and effective tool for restoring blood flow, improving the safety of endovascular treatment.

scholarly journals Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula

2020 ◽  
pp. 159101992093896
Author(s):  
Wen-Tao Yan ◽  
Xiu-Zhen Li ◽  
Chang-Xiang Yan ◽  
Jia-Chun Liu
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Computer Tomography ◽  
Sigmoid Sinus ◽  
Subdural Effusion ◽  
Severe Stenosis ◽  
History Of ◽  
Pial Arteriovenous Fistula ◽  
The Right

Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively.

scholarly journals Endovascular Treatment of Patients with Popliteal Artery Aneurysms (a Literature Review)

2020 ◽  
Vol 8 (4) ◽  
pp. 437-442
Author(s):  
S. A. Prozorov
Keyword(s):  
Endovascular Treatment ◽  
Popliteal Artery ◽  
Length Of Hospital Stay ◽  
Wound Complication ◽  
Clinical Results ◽  
Conflicts Of Interests ◽  
Stent Grafts ◽  
Long Term Follow Up

The purpose of this review is to evaluate the results endovascular treatment of popliteal artery aneurysms. Endovascular treatment using stent grafts is a safe and effective alternative to open surgical repair, has a lower wound complication rate and shorter length of hospital stay, satisfactory technical and clinical results even at long-term follow-up. In patients requiring long segment coverage or numerous stents, the poor state of distal blood flow may increase the risk of failure. Careful patient selection, proper operative technique and adequate sizes of stent grafts are required for good outcomes.Author declare lack of the conflicts of interests.

scholarly journals Stenting for Abrupt Closure of the Intracranial Vertebral Artery Complicating Balloon Angioplasty

2000 ◽  
Vol 6 (3) ◽  
pp. 235-238 ◽  
Author(s):  
T. Hatano ◽  
T. Tsukahara ◽  
K. Araki
Keyword(s):  
Coronary Artery ◽  
Vertebral Artery ◽  
Balloon Angioplasty ◽  
Endovascular Procedures ◽  
Therapeutic Option ◽  
Intracranial Artery ◽  
Acute Occlusion ◽  
Bail Out

We report a case of stenting for abrupt closure of the intracranial vertebral artery complicating balloon angioplasty. A 58-year-old man with symptomatic restenosis of the intracranial vertebral artery underwent balloon angioplasty, which was complicated by acute occlusion due to wall dissection. The acute occlusion of the lesion was completely recanalized by implanting a balloon-expandable stent designed for the coronary artery. Follow-up angiography 15 months after stenting did not show severe restenosis and the patient's symptoms disappeared after stenting. This therapeutic option may be useful as a means to bail out from acute occlusion of the intracranial artery caused by endovascular procedures.

Outcomes, Complications, and Technical Aspects of One-Level Vertebral Column Decancellation Osteotomy for Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience of 39 Patients with Minimum 2-Year Follow-Up

2020 ◽  
Author(s):  
Zhijun Xin ◽  
Guoquan Zheng ◽  
Xinwen Feng ◽  
Peng Huang ◽  
Xuesong Zhang ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Blood Loss ◽  
Vertebral Column ◽  
Perioperative Complications ◽  
Operation Time ◽  
Clinical Results ◽  
Kyphotic Deformity ◽  
Thoracolumbar Kyphosis ◽  
Complete Paralysis

Abstract Objective To evaluate the safety and efficacy of one-level vertebral column decancellation (VCD) for the correction of thoracolumbar kyphosis in ankylosing spondylitis (AS) will beneficial for clarify the application of this procedure. Methods With a minimum 2-year follow-up, 39 AS patients with kyphotic deformity who underwent one-level VCD were retrospectively reviewed. The operation time, blood loss, and perioperative complications were investigated to evaluate the technical safety. Pre- and postoperative radiographic and clinical parameters were compared to evaluate the technical efficacy. Results All of the osteotomy sites were located between T12 and L3. With an average operation time of 257.8±49.9 minutes, the average blood loss was 596.1±218 ml. 4 patients (10.3%) experienced complications during the follow-up period, while no deaths or complete paralysis were occurred. With an average correction of 45.07±11.27° have obtained for one-level VCD, the radiographic parameters improved significantly from preoperative to postoperative, including global kyphosis (from 42.05±13.82° to 1.51±12.08°), local kyphosis (from 20.54±15.43° to -24.54±12.83°), lumbar lordosis (from -8.01±16.34° to -42.81±13.98°), and SVA (from 17.47±6.77 cm to 7.45±5.37). At final follow-up, the clinical results were significantly improved compared with the preoperative results, including VAS for back pain (from 6.82±0.91 to 0.15±0.37), CBVA (from 30.44±10.81° to 10.10±3.92°) and all items of SRS-22 questionnaire. Conclusion With an acceptable complication rate, one-level VCD is an effective technique which can provide an average correction of 45° for correcting kyphotic deformity caused by AS, and can achieve good results even for severe AS kyphosis with a necessary correction angular up to 60°.

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