JNET最新文献

{"title":"Review of Distal Embolism with Respect to Filters for Carotid Artery Stenting","authors":"K. Hayashi, Y. Matsunaga, Yukishige Hayashi, K. Shirakawa, M. Iwanaga","doi":"10.5797/JNET.OA.2018-0048","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0048","url":null,"abstract":"Objective: Carotid artery stenting is performed using a device for preventing distal embolism because vasodilationrelated debris may cause cerebral infarction. Concerning filters for preventing embolism, membrane-type filters have been used, but mesh-type filters became commercially available. We have selected filter-assisted stenting as a first-choice procedure. We examined post-treatment filters under a microscope, and reviewed the pathogenesis of distal embolism. Methods: The subjects were 83 patients in whom carotid artery stenting with a filter was performed, and filters could be examined after surgery (Angioguard XP [AG; Cordis Corporation, Miami Lakes, FL, USA]: 25 patients, Filterwire EZ [FW; Boston Scientific, Natick MA, USA]: 32, and Spider FX [Spider; Covidien, Dublin, Ireland]: 26). After treatment, the filters were stained with hematoxylin and eosin (HE), separated from the struts, and embedded in preparations for microscopic observation. Debris was classified into plaque-derived and fibrin-formation types, and quantified as an area using computer software. Distal embolism was evaluated based on intraoperative flow impairment, postoperative symptoms, and perioperative diagnostic imaging findings. Results: Intraoperative flow impairment was noted in six patients (24%) in the AG group, five (15.6%) in the FW group, and one (3.8%) in the Spider group. Cerebral infarction was observed in three (12%), two (6.3%), and two (7.6%) patients, respectively. There were no differences in the volume of plaque-derived debris, but the volume of fibrin-formation-type debris was more in the AG group. As a result, the volume of debris collected was more. In the Spider group, the volume of fibrin-formation-type debris was minimum. Conclusion: Functions differed between the membrane-type and mesh-type filters. Considering their performance, these filters should be used.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058429","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":"Angiographical Features of Acute Stroke Patients with Carotid Artery Embolic Occlusion Recanalized by Suction with Syringe via Balloon Guiding Catheter","authors":"H. Yamazaki, K. Imai, M. Hamanaka, M. Itsukage, K. Tsuto, A. Yamamoto, T. Ioku, Takehiro Yamada, Takuma Nakamura, H. Takezawa, N. Tokuda","doi":"10.5797/JNET.OA.2018-0053","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0053","url":null,"abstract":"Objective: This study was conducted to clarify the characteristics of preprocedural vascular images in patients with acute embolic occlusion of the carotid artery in whom the internal carotid artery (ICA) could be recanalized by manual suction with syringe via the balloon guiding catheter (SS-BGC) alone. Methods: The subjects were 64 consecutive patients who underwent SS-BGC for carotid artery embolic occlusion at our institution between May 2006 and September 2017. The subjects were classified into those who with recanalization (R-SS-BGC group) and no recanalization (N-SS-BGC) of ICA by SS-BGC alone, and the background factors including findings of preprocedural vascular imaging and outcomes were compared between the two groups. Results: The R-SS-BGC and N-SS-BGC groups consisted of 16 and 48 patients, respectively. In the R-SS-BGC/N-SS-BGC groups, the horizontal segment of the ipsilateral anterior cerebral artery (A1) was patent in 15/24 (94/50%) and the horizontal segment of the ipsilateral middle cerebral artery (M1) was patent in 6/16 (38/34%) on preprocedural MRA. The ipsilateral posterior communicating artery (PcomA) was patent in 3/14 (19/29%) and the ipsilateral ophthalmic artery (OphA) was patent in 1/14 (6/29%) on preprocedural angiography. The median duration of operation was 39/86.5 minutes, and complete recanalization could be achieved in 15/34 (94/71%). The outcome was favorable in 10/11 (63/23%). Conclusion: In the R-SS-BGC group, the percentages of patients with patent ipsilateral A1 and M1 were high, and the percentages of those with patent ipsilateral PcomA and OphA were low.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058488","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 in Whom Straightening of a Parent Vessel Related to Insertion of a Braided Stent Contributed to Complete Occlusion of an Intracranial Aneurysm","authors":"T. Fujii, H. Oishi, Kohsuke Teranishi, K. Yatomi, Munetaka Yamamoto","doi":"10.5797/JNET.CR.2018-0034","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0034","url":null,"abstract":"Objective: We report a patient in whom vascular straightening was achieved after stent-assisted coil embolization, leading to complete occlusion of an intracranial aneurysm after 1 year. Case Presentation: The patient was a 60-year-old female. A medical checkup of the brain showed a posterior inferior cerebellar artery (PICA) aneurysm. Under general anesthesia, coil embolization was performed. During surgery, a coil deviated onto the PICA side, and a stent was deployed so that the aneurysmal neck might be located at its center. Finally, incomplete occlusion of the aneurysm was achieved. Cerebral angiography 1 year after surgery indicated a sharper branching angle of the blood vessel in comparison with the preoperative angle and complete occlusion of the aneurysm. Conclusion: A braided stent inserted to a site where a thin parent vessel is not fixed by the peripheral structure may make the parent vessel straight, contributing to complete occlusion of an aneurysm.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055681","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":"Intraventricular Hemorrhage due to a Distal Anterior Choroidal Artery Aneurysm Associated with an Arteriovenous Malformation in the Trigone","authors":"Shunsuke Magami, H. Oishi, H. Mitsuoka, K. Suda, H. Arai","doi":"10.5797/jnet.cr.2019-0064","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0064","url":null,"abstract":"Objective: We herein describe a rare case of intraventricular hemorrhage (IVH) due to a distal anterior choroidal artery (AChA) aneurysm associated with an arteriovenous malformation (AVM) in the trigone of the lateral ventricle during early pregnancy. Case Presentation: At 8 weeks of pregnancy, a 36-year-old woman developed sensory aphasia and mild right hemiparesis due to a left lateral IVH. Digital subtraction angiography showed a peripherally located aneurysm branching from the medial perforating branch (MPB) of the plexal segment in the AChA associated with a micro-AVM in the trigone of the left lateral ventricle. Endovascular embolization was performed. A microcatheter was guided to a feeder branching out from the MPB. The aneurysm and the nidus, including the feeder, were occluded by 20% n-butyl-2cyanoacrylate (NBCA). However, right homonymous hemianopsia was apparent postoperatively, although the blood flow of the cisternal segment was preserved. Head MRI showed an acute infarction in the perfusion area of the AChA, including the internal capsule and optic radiation. Conclusion: We performed endovascular embolization to temporarily treat both the aneurysm and the nidus because the source of bleeding was unclear considering the hematoma position and angiographic features. Ischemic complications of the embolization for the aneurysm and the nidus with the preservation of the cisternal segment of the AChA are unusual.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056273","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":"Cerebral Ischemic Complications of Subclavian Artery Stenting: Relationship between Lesion Location and Procedural Strategy","authors":"M. Arihara, K. Miyata, Satoshi Iihoshi, R. Yokoyama, Ayumu Yamaoka, Yuto Suzuki, T. Mikami, M. Wanibuchi, N. Mikuni","doi":"10.5797/jnet.oa.2019-0034","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0034","url":null,"abstract":"Objective: Clinical research demonstrating safety and security in subclavian artery stenting (SAS) is limited because treatment strategies for SAS vary greatly among institutions, operators, and clinical conditions, as no standard protocol exists. As stenotic lesions frequently occur in the proximal portion of the subclavian artery (SA), it is often difficult to stabilize the guiding catheter for stent delivery. Our purpose was to assess whether lesion location can be used to predict optimal procedural strategies. Methods: We performed a retrospective, single-center observational study on 26 consecutive patients who underwent SAS between 2004 and 2016. We categorized patients treated with SAS into two groups according to lesion location: those with lesions located less than 10 mm from the origin of the SA (Group P) and those with lesions in the distal portion (Group D). We defined a bidirectional approach via both brachial and femoral puncture as well as bilateral brachial puncture as combined access. In pull-through method, a guidewire was passed from one sheath to another. We compared Group P with Group D in terms of procedural strategy and efficacy. Results: All 26 cases were clinically successful. Asymptomatic cerebral embolism was found in 10 (48%) of 21 cases in which postoperative MRI was performed, and the number of spotty lesions was less than four in every patient. Arterial access-site complications were documented in eight patients. Two cases of late in-stent restenosis were retreated with balloon dilatation. Cases with retrograde ipsilateral vertebral artery (VA) blood flow and symptomatic lesions occurred more frequently in Group P than in Group D (79% vs. 42%; p = 0.06, 71% vs. 33%; p = 0.05, respectively). Patients in Group P were significantly more often treated with combined access (100% vs. 42%; p = 0.001), with the pull-through method (64% vs. 0%; p < 0.001) than those in Group D. The distal end of the stent was involved with the ipsilateral VA orifice more often in Group D than in Group P (50% vs. 7%; p = 0.02). Conclusion: These results demonstrate that our strategy is a safe and effective method of stenting for SA stenosis in the portion of the artery that is proximal to the aorta. We should pay special attention to the risk of arterial access-site complications.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71059164","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 Dural Arteriovenous Fistula Involving the Inferior Petroclival Vein","authors":"N. Hayashi, M. Kawanishi, S. Okubo, N. Osaka, K. Osaka, T. Tamiya","doi":"10.5797/JNET.CR.2018-0084","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0084","url":null,"abstract":"Objective: We report a very rare case of dural arteriovenous fistula (DAVF) involving the inferior petroclival vein (IPCV). Case Presentation : The patient was a 77-year-old woman. She suffered from right ophthalmalgia, pulsatile tinnitus, blepharedema, and chemosis, as well as right ptosis and diplopia (right oculomotor nerve palsy). Our imaging examinations demonstrated DAVF involving the IPCV. Since the proximal side of the right inferior petrosal sinus (IPS) was obstructed, the main venous drainage flow refluxed retrogradely from the IPS to the cavernous sinus (CS). Therefore, her clinical symptoms were similar to those of CS-DAVF. We successfully performed transvenous coil embolization (TVE) in the IPCV and IPS. Conclusion: We experienced a very rare case of DAVF involving the IPCV. We believe that it is important in each case to understand the 3D vascular anatomy by making full use of 3D-DSA and other modalities to accurately identify the shunt point and venous drainage structure.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056019","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":"Mechanical Thrombectomy as an Initial Treatment for Sinus Thrombosis","authors":"Yusuke Takahashi, Y. Suda, A. Saito, Ryosei Wakasa","doi":"10.5797/jnet.cr.2019-0065","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0065","url":null,"abstract":"Objective: Sinus thrombosis often deteriorates despite anticoagulation therapy. Early endovascular therapy may lead to a better outcome in such cases. We report a case of sinus thrombosis treated by mechanical thrombectomy as an initial treatment. Case Presentation: A 45-year-old female presented with headache and tonic seizure affecting the right arm. Computed tomography revealed subcortical hemorrhage at the right superior frontal gyrus. Occlusion of the superior sagittal sinus (SSS) was found on CTA and we diagnosed sinus thrombosis. Digital subtraction angiography demonstrated complete occlusion of the SSS and venous congestion at the middle third of the SSS. Immediately after diagnosis, we performed mechanical thrombectomy as an initial treatment. Partial recanalization was achieved after mechanical thrombectomy. Postoperative anticoagulation therapy was continued, and her symptom was improved. Conclusion: Mechanical thrombectomy as an initial treatment for sinus thrombosis may be a useful treatment option when aggravation of the symptoms is predicted.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.cr.2019-0065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056320","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 Cervical Vertebral Arteriovenous Fistula Which Manifested as Radiculopathy: A Case Complicated by Neurofibromatosis Type 1","authors":"Takeaki Totsuka, H. Hiramatsu, Tomoya Ohishi, Shusuke Matsui, M. Kamiya, H. Nanba","doi":"10.5797/jnet.cr.2019-0025","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0025","url":null,"abstract":"Objective: In this report, we describe a case of cervical vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type 1(NF1) presented as radiculopathy. Case Presentation: A 65-year-old female patient diagnosed with left cervical vertebral artery lesion-like aneurysms and NF1 incidentally. After 5 years, she presented with neck pain and left upper weakness. Examinations revealed left vertebral AVF. Endovascular therapy was performed and her symptoms were improved. Conclusion: Endovascular therapy should be performed if asymptomatic cervical vertebral aneurysms associated with NF1 are growing or become symptomatic.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.cr.2019-0025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056594","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":"High Age Could Influence Large Thrombus Aspiration Catheter Advancement over the Carotid Siphon","authors":"Y. Matsumoto, Hayatsura Hanada, K. Nii, Yusuke Morinaga, M. Iko, Takafumi Mitsutake, A. Eto, H. Aikawa, K. Kazekawa, M. Tsutsumi","doi":"10.5797/JNET.OA.2018-0044","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0044","url":null,"abstract":"Objective: A direct aspiration technique using a 5MAX ACE catheter (Penumbra, Alameda, CA, USA) has been reported. However, recanalization has not been achieved in all cases with this technique alone. Additionally, Japan has a rapidly aging society, and differences in the condition of vessels, because of aging, can limit the approach of revascularization devices to the thrombus. We evaluated the accessibility of the 5MAX ACE (0.060-inch inner diameter) over the clinoid segment of the internal carotid artery (ICA). Methods: We conducted a retrospective and cross-sectional study of 28 patients who received intraarterial treatment for acute ischemic stroke between October 2014 and October 2016. We recorded the maximum distal arrival point of the distal edge of the 5MAX ACE during the procedure before the stent retriever was retrieved. Results: In 5 of the 28 patients, the distal edge of the 5MAX ACE catheter did not advance over the clinoid segment of the ICA. The mean age of patients for whom the 5MAX ACE catheter failed to advance over the clinoid segment of the ICA was significantly higher (non-advancement: 85 ± 3 years) than that of patients with advancement (76 ± 9 years, Mann–Whitney U-test: P = 0.04). Conclusion: Advanced age may limit successful revascularization using only a direct aspiration technique with the 5MAX ACE without a stent or balloon anchoring technique for lesions at the terminal portion of the ICA and more distal arteries, which suggests that different devices or approaches may be needed for clot removal.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058197","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":"Selection of Appropriate Inner Catheter for Placement of Guiding Catheter","authors":"Y. Nishikawa, Kentaro Tanaka, T. Kitamura, Teishiki Shibata, H. Yamada, M. Oomura, Noriaki Aihara, H. Katano, S. Osaga, M. Mase","doi":"10.5797/JNET.OA.2018-0090","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0090","url":null,"abstract":"Objective: Occasions to administer endovascular treatment to the elderly have increased, for which rapid and safe guiding catheter (GC) placement even in a lesion with seve re arteriosclerosis is required. We investigated an index to easily evaluate the degree of diffi culty before treatment. Methods: In all, 83 consecutive patients who received carotid artery stenting (CAS) through the transfemoral approach at our institution between May 2010 and December 2016 were divided into those in whom GC could be placed using the JB2-type inner catheter (IC) (JB2 group) and those who required the Simmon s type or Goose neck snare (SM/GS group). Vascular anatomy of the cervicothoracic region was evaluated and an index to select IC was investigated. Results: The JB2 and SM/GS groups consisted of 68 and 15 patients, respectively. The distributions of the following fi ve items were diff erent between the two groups: The level of the origin of the selected artery from the lesser curvature of t he aortic arch, aorta type, tortuosity of the common carotid artery, selected artery, and location of the lesion. On decision tree analysis of these factors, a fl owchart was prepared in which a lower level of the origin of the selected artery than the level of the lesser curvature of the aortic arch was the fi rst layer. Conclusion: IC selection can be more accurately evaluated based on whether the level of the origin of the selected artery is lower than the level of the lesser curvature of the aortic arch compared with evaluation of the aorta type III.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058394","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}