JNET最新文献

{"title":"A Case of Brainstem Arteriovenous Malformation Cured by Transvenous Embolization with Onyx","authors":"Y. Tsuboi, Tomoaki Terada, H. Itokawa, S. Yamana, Michihisa Narikiyo, Norio Fujii, H. Nagasaki, Seiya Nagao, Chisaku Kambayashi","doi":"10.5797/jnet.cr.2019-0036","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0036","url":null,"abstract":"Objective: We report a case of ruptured brain stem arteriovenous malformation that was successfully treated by transvenous embolization in addition to transarterial embolization using Onyx. Case Presentation: A 61-year-old woman was admitted because of consciousness disorder following sudden-onset headache. CT revealed brain stem hemorrhage and MRI revealed abnormal vessels around the brainstem. Cerebral arteriovenous malformation on the right side of the pons was identified from an angiography. Her consciousness gradually improved from conservative treatment. Thereafter, endovascular treatment was performed. First, transarterial embolization with Onyx was performed to reduce the nidus as much as possible. Then, transvenous embolization for the remaining nidus was performed to completely embolize the cerebral arteriovenous malformation. No new neurological deficits were observed after treatment and no recurrence was noted on follow-up angiography 1 month after treatment. Conclusion: We treated the brainstem arteriovenous malformation using a combination of transvenous and transarterial embolizations. In suitable cases, transvenous embolization can be an alternative treatment for deep-seated cerebral arteriovenous malformations that are difficult to treat by transarterial embolization or direct surgery.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.cr.2019-0036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41373981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Ruptured Vertebral Artery Dissection Involving the Origin of the Posterior Inferior Cerebellar Artery Was Conserved by Placing a Stent via the Contralateral Vertebral Artery","authors":"A. Tsuji, H. Kayatani, K. Tsuji, Y. Yoshimura, T. Yokoi, T. Nakazawa, K. Nozaki","doi":"10.5797/jnet.cr.2019-0043","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0043","url":null,"abstract":"Objective: We report the first case of a vertebral artery (VA) dissecting aneurysm involving the posterior inferior cerebellar artery (PICA) treated by placing a stent on the PICA from the contralateral VA and parent artery occlusion in the acute hemorrhagic phase. Case Presentation: The patient was a 47-year-old man with World Federation of Neurosurgical Societies (WFNS) grade 3 subarachnoid hemorrhage (SAH) and a VA dissecting aneurysm involving the origin of the PICA. We approached from the contralateral VA, and placed a stent from the PICA to VA to preserve the PICA, and parent artery occlusion of the VA was performed. As of 6 months postoperatively, no rebleeding or recurrence of aneurysm has been observed. Conclusion: Although the use of stents in the acute phase is difficult, they can fully preserve the PICA and parent artery occlusion, and may be an effective treatment method to prevent rebleeding and chronic phase recurrence.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46356572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Outcome Using Insertable Cardiac Monitoring in Patients with Cryptogenic Stroke after Thrombectomy","authors":"R. Doijiri, Naoto Kimura, Ken Takahashi, Hideaki Endo, Michiko Yokosawa, Hiroaki Takahashi, T. Sugawara, Takahiko Kikuchi","doi":"10.5797/jnet.oa.2019-0042","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0042","url":null,"abstract":"Objective: Insertable cardiac monitoring (ICM) systems are useful for diagnosing paroxysmal atrial fibrillation (PAF) in cryptogenic stroke (CS). We assessed the initial treatment outcome using insertable cardiac monitors in CS treated by endovascular reperfusion therapy. Methods: Of 102 consecutive acute ischemic stroke patients with large vessel occlusion (LVO) treated by endovascular therapy, we included 10 with CS who underwent insertable cardiac monitor placement between December 2016 and June 2018 at our hospital. Atrial fibrillation (AF) was determined by performing screening tests such as 12-lead electrocardiography (ECG), Holter ECG, and continued electrocardiographic monitoring for 3 days. Transesophageal echocardiogram (TEE) was essential to diagnose CS. We analyzed the parameters of AF and the time at which AF was first detected within 1 year. Results: There were eight (80%) male patients, and the median age was 68 (interquartile range [IQR]: 59–76) years. The parameters of AF were not outliers. The detection rate of AF at 12 months was 60%. The median time from onset of stroke to device insertion was 17 (range: 10–22) days, and the median time from device insertion to detection of the first AF episode was 52 (range: 12–344) days. Conclusion: The detection rate of AF in acute ischemic stroke patients with LVO treated by endovascular therapy was higher than that in previous reports.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41949782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Spontaneous High-flow Vertebral Arteriovenous Fistula Treated by Trans-arterial Target Embolization Using Balloon Remodeling Technique","authors":"S. Kawada, K. Sugiu","doi":"10.5797/jnet.cr.2019-0044","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0044","url":null,"abstract":"Objective: Spontaneous vertebral arteriovenous fistula (VAVF) is a rare vascular disorder. Herein, we report a case of high-flow VAVF with ipsilateral persistent primitive trigeminal artery (PPTA) treated by trans-arterial target embolization (TE) using balloon remodeling technique (BRT). Case Presentation: A 58-year-old woman with a medical history of non-tuberculous mycobacterial lung disease had complained of right-sided pulsatile tinnitus for 3 years; however, there were no symptoms due to brain or spinal cord dysfunction. DSA revealed high-flow VAVF in the right V3 segment at the C2 vertebral body level and ipsilateral PPTA. The multi-planar reconstruction (MPR) images of cone-beam CT (CB-CT) obtained from 3D rotational angiography (3D-RA) in the arterial phase were useful to evaluate the morphology of VAVF. The fistula was single and positioned in the V3 segment at the C2 vertebral body level. The venous side of the fistula had expanded into a spheroid-like shape. A planned trans-arterial TE was performed 39 months after diagnosis due to recurring lung hemorrhage. Using BRT, TE was successful by packing back from the spheroid-like space with coils. The spheroid-like space was located slightly caudal to the fistula, and occlusion balloon inflated just distal to the fistula was helpful to navigate the microcatheter. After 12 months, DSA showed no recurrence of VAVF. Conclusion: The MPR images of CB-CT obtained from 3D-RA were useful for evaluation of the morphological structure of VAVF. The BRT was useful for successful TE.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.cr.2019-0044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42958816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient with Repeated Hemorrhage during Coil Embolization of Aspergillus Aneurysm Rupture","authors":"Akira Wakako, S. Nagahisa, M. Oeda, Hirotaka Kogame, A. Sadato","doi":"10.5797/JNET.CR.2018-0120","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0120","url":null,"abstract":"Objective: There are few reports of fungal aneurysms developing in the basilar artery where endovascular therapy has been provided. Cerebral infarction was observed before the occurrence of the aneurysm. The aneurysm ruptured repeatedly during treatment. Since the clinical course was complicated, it is reviewed in the literature. Case Presentation: A 71-year-old female patient receiving chemotherapy was admitted with a chief complaint of fever. On the day of hospitalization, right-sided paralysis appeared. MRI confirmed a pontine infarction. A sudden decrease in the consciousness level was observed on the 7th day of hospitalization. Head CT showed subarachnoid hemorrhage. The formation of a basilar artery aneurysm was confirmed on 3D-CTA. We suspected an infectious aneurysm and treated using coil embolization. This aneurysm ruptured repeatedly during treatment. The patient died on the 28th day of hospitalization. From the cerebrospinal fluid examination and autopsy results, subarachnoid hemorrhage due to ruptured infectious aneurysm caused by Aspergillus was diagnosed. Conclusion: An endosaccular embolization of an Aspergillus aneurysm caused repeated intraoperative rupture and the prognosis was poor.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44027430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Mechanical Reperfusion Therapy for Cerebral Infarction Induced by Tumor Embolism from Lung Cancer","authors":"Yuichiro Tsurusaki, Kenta Takahara, Noriyuki Koga, T. Amano, S. Haga, S. Arihiro","doi":"10.5797/JNET.CR.2018-0138","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0138","url":null,"abstract":"Objective: We report a case of cerebral infarction with mechanical reperfusion therapy for tumor embolism caused by lung cancer. Case Presentation: The patient was a 72-year-old man. We performed emergency mechanical thrombectomy alone for acute left internal cerebral artery (ICA) occlusion and achieved complete reperfusion at the fifth pass with Trevo 4 × 20 mm. Pathologically, the embolus was diagnosed as squamous cell carcinoma. In chest contrast CT, lung cancer invaded the left atrium and pulmonary vein, diagnosed as tumor embolism by this invading tumor. Conclusion: We experienced a very rare case of tumor embolism caused by lung cancer. Although it was difficult to re-canalize, the strut structure of Trevo and push and fluff technique may have been effective against the hard embolus.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46944027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Therapy of Distal Anterior Cerebral Artery Aneurysms: Single-institution Clinical Experience with 47 Patients (49 Aneurysms)","authors":"Kazumoto Suzuki, K. Yatomi, Munetaka Yamamoto, H. Oishi, H. Arai","doi":"10.5797/JNET.OA.2019-0004","DOIUrl":"https://doi.org/10.5797/JNET.OA.2019-0004","url":null,"abstract":"","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47051535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Middle Meningeal Artery Embolization for Organized Chronic Subdural Hematoma","authors":"Daisuke Izawa, H. Matsumoto, Hirokazu Nishiyama, N. Toki, Takumi Kawaguchi, Rie Yako, N. Nakao","doi":"10.5797/JNET.OA.2018-0116","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0116","url":null,"abstract":"Objective: This study evaluated the efficacy of middle meningeal artery (MMA) embolization for organized chronic subdural hematoma (OCSDH). Methods: Between 2013 and 2017 at our institution, 11 consecutive patients with 14 OCSDH lesions required MMA embolization, accounting for 4.5% of the 314 patients treated for chronic subdural hematoma (CSDH) in this period. Initially, all lesions underwent burr-hole surgery (BHS) under local anesthesia. At the regrowth, BHS was first performed under local anesthesia. OCSDH was diagnosed based on second-operative findings and postoperative CT or magnetic resonance imaging of the brain, and MMA embolization was performed for OCSDH. We investigated the efficacy of MMA embolization in reducing the hematoma and preventing regrowth of OCSDH. Results: In the second surgery, 12 lesions underwent BHS. Additionally, two lesions were treated with small craniotomy after BHS under local anesthesia. In all lesions, MMA embolization was performed within 3 weeks after the second surgery. In all, 12 lesions improved on brain CT within 2–4 weeks. Two lesions underwent craniotomy and membranectomy under general anesthesia, 2 and 10 days after MMA embolization. In one case, the BHS and small craniotomy were insufficient to reduce the mass effect. In the other case, infectious CSDH was diagnosed at craniotomy. Conclusions: MMA embolization may be effective additional modality for OCSDH after BHS.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46018648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Treatment Results of In-hospital Acute Ischemic Stroke due to Large Vessel Occlusion Treated by Mechanical Thrombectomy","authors":"N. Matsubara, R. Hiramatsu, Ryokichi Yagi, H. Ohnishi, S. Miyachi, G. Futamura, Y. Tsuji, Yangtae Park, S. Kawabata, T. Kuroiwa","doi":"10.5797/JNET.OA.2018-0134","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0134","url":null,"abstract":"Objective: The purpose of this study was to investigate the characteristics, time-line, and treatment results of in-hospital acute ischemic stroke due to large vessel occlusion (LVO) treated by mechanical thrombectomy. Methods: The authors investigated 10 patients (six males and four females; mean age 78.6 years, range 65–92) with in-hospital LVO treated by thrombectomy between January 2016 and July 2018 in our institute. Patient characteristics, procedural results, clinical outcome, and time-line data of thrombectomy (last well known [LWK]/onset, recognition, arterial puncture, and recanalization) were retrospectively evaluated. Results obtained from in-hospital LVO were compared with those from 13 patients with community-onset LVO (eight males and five females; mean age 78.3 years, range 45–87). Results: The initial admitting departments of in-hospital LVO were cardiology in six (60%) and hematology, otolaryngology, urology, and gastroenterology in one each (10%). The etiologies of ischemic stroke were cardioembolism in eight (80%), thrombosis in one (10%), and iatrogenic consequence in one (10%). The comorbid disease of in-hospital LVO included cardiac disease in eight (80%) and malignant tumor in four (40%) with overlapping. The factor contributing to in-hospital LVO was invasive procedure with withdrawal of antithrombotic agents in three (30%). The interval between LWK and recognition was a median of 60 minutes in in-hospital LVO, which was shorter than LWK-to-arrival time in communityonset LVO (medial 225 minutes). The interval between recognition and consultation to the neuroendovascular team was a median of 50 minutes. The recognition-to-puncture time was compared with arrival-to-puncture time in communityonset LVO. That presented no difference between them (median 130 vs 150 minutes). The LWK-to-recanalization time in in-hospital LVO was shorter than that in community-onset LVO (median 240 vs 495 minutes). The procedural results of thrombectomy demonstrated no differences between them. The rate of thrombolysis in cerebral infarction (TICI) 2b-3 was 70% in in-hospital vs 85% in community-onset LVO. The rate of favorable outcome (modified Rankin Scale [mRS] 0-2) at discharge was not different (30% vs 23%); however, higher rates of mortality and severe disability (mRS 5-6) were observed in patients with in-hospital LVO compared to those with community-onset LVO (40% vs 15%). Conclusion: In this series, the procedural results of thrombectomy were not different between in-hospital and communityonset LVO. The recognition-to-puncture time in in-hospital LVO was similar to the arrival-to-puncture time in community-onset LVO, although the LWK-to-recognition/recanalization time in in-hospital LVO was shorter compared with the LWK-toarrival/recanalization-time in community-onset LVO. The rate of clinical favorable outcome was similar, although a higher rate of poor outcome was observed in in-hospital LVO. Comorbid diseases may be associated with po","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45620274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient with a Pseudoaneurysm of the Middle Meningeal Artery Who Developed Intracerebral Hemorrhage during Conservative Treatment for Traumatic Subarachnoid Hemorrhage","authors":"Seigo Kimura, Ryokichi Yagi, Ryo Tamaki, D. Ogawa, T. Manno, H. Taniguchi, T. Kuroiwa","doi":"10.5797/JNET.CR.2018-0104","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0104","url":null,"abstract":"Objective: We report a 73-year-old male in whom a traumatic pseudoaneurysm of the middle meningeal artery (PMMA) increased during conservative treatment for traumatic subarachnoid hemorrhage, an acute subdural hematoma, and brain contusion, leading to intracerebral hemorrhage related to its rupture. Case Presentation: During decommissioning operations, he fell down from the bed of a truck, and was brought to our hospital by ambulance. Head CT revealed traumatic subarachnoid hemorrhage, left acute subdural hematoma, and brain contusion. Conservative treatment was performed. Left temporal lobe hemorrhage related to the rupture of a traumatic pseudoaneurysm of the left middle meningeal artery (MMA) was observed 20 days after onset. Emergency endovascular treatment and hematoma removal under craniotomy were conducted. Conclusion: In cases of subarachnoid hemorrhage after head trauma, serial changes should be assessed using CTA and DSA, considering the possibility of a traumatic PMMA.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48066397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}