Journal of neuroendovascular therapy最新文献

{"title":"The Glymphatic System and Its Role in Neurovascular Diseases.","authors":"Timo Krings, Yushin Takemoto, Kentaro Mori, Tze Phei Kee","doi":"10.5797/jnet.ra.2025-0020","DOIUrl":"10.5797/jnet.ra.2025-0020","url":null,"abstract":"<p><p>Over the past decade, clinicians and researchers have increasingly recognized the significance of the glymphatic system. Evidence demonstrates that this system-named for its reliance on astrocyte endfeet of glial cells and its lymphatic-like waste clearance function from the brain-is essential for regulating the accumulation and removal of amyloid aggregates and other interstitial waste products that may cause cognitive decline if not removed. Its activity is highly regulated, with flow driven by arterial wall pulsatility linked to the cardiac cycle, facilitating perivascular cerebrospinal fluid (CSF) influx into the brain interstitium and its efflux into the venous system. In the present review, we highlight the interplay between the glymphatic system and neurovascular diseases, as well as conditions that are currently being treated by endovascular means, including subarachnoid hemorrhage, idiopathic intracranial hypertension, steno-occlusive disease, and arteriovenous shunting diseases. We describe how changes in arterial pulsatility, disturbances in para-arterial CSF influx, changes in aquaporin-4 receptor composition, or venous hypertension with a decreased arteriovenous pressure gradient can cause dysfunction of different components of the glymphatic system, leading to similar clinical symptomatology with progressive cognitive decline that may be reversible.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Thrombectomy for Medium Vessel Occlusion with Extracranial Vessel Tortuosity Using Quadruple Coaxial System: A Case Series.","authors":"Yusuke Nakazawa, Takeshi Miyata, Koki Mitani, Ryo Hamamoto, Takashi Nagahori, Wataru Yoshizaki, Takao Morita, Yuji Agawa, Takenori Ogura, Yu Abekura, Yukiko Inamori, Wataru Shiraishi, Taketo Hatano","doi":"10.5797/jnet.oa.2025-0018","DOIUrl":"10.5797/jnet.oa.2025-0018","url":null,"abstract":"<p><strong>Objective: </strong>Medium vessel occlusions (MeVOs) during acute ischemic stroke present challenges due to their distal occlusion sites. Furthermore, MeVO cases with tortuous extracranial vessels are complex, and effective management techniques are lacking. This study reports the utility of combining a 6-French distal access catheter with a low-profile aspiration catheter, guiding catheter, and microcatheter to establish a quadruple coaxial system for treating MeVOs with tortuous extracranial vessels.</p><p><strong>Methods: </strong>We retrospectively reviewed data from mechanical thrombectomy cases with MeVO at our institution between March 2022 and February 2024. A total of 81 patients were enrolled, and 5 patients were treated using the quadruple coaxial system. The primary efficacy outcome was the first pass effect (FPE), and the rate of successful recanalization, determined by the expanded thrombolysis in cerebral infarction (eTICI 2b/3) at the end of treatment. The safety assessment included hemorrhagic and procedure-related complications.</p><p><strong>Results: </strong>Of the 81 enrolled patients, 5 patients were treated using the quadruple coaxial system. Three men and 2 women, with a mean age of 77 years, were included in this study. The median baseline National Institutes of Health Stroke Scale score was 10 points, and a tissue plasminogen activator was administered to 2 patients. Four patients had M2 occlusions, and 1 patient had a P2 occlusion. In 4 cases, the guiding system could not be advanced distally because of extracranial vessel tortuosity. The quadruple coaxial system achieved a significantly higher rate of FPE (80% vs. 30%; P = 0.0401) than the standard coaxial system, with no postoperative intracerebral hemorrhage or procedure-related complications.</p><p><strong>Conclusion: </strong>The quadruple coaxial system is a valuable approach for treating MeVOs with severe extracranial vessel tortuosity. This system offers a reliable and safe treatment modality when a guiding system cannot be advanced distally.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bailout Technique for Protrusion and Migration of Detached Woven EndoBridge Devices with Amplatz Goose Neck Microsnare.","authors":"Takeya Suzuki, Ichiro Nakahara, Shoji Matsumoto, Jun Morioka, Tetsuya Hashimoto, Akiko Hasebe, Jun Tanabe, Junpei Koge, Sadayoshi Watanabe, Kenichiro Suyama","doi":"10.5797/jnet.tn.2024-0063","DOIUrl":"10.5797/jnet.tn.2024-0063","url":null,"abstract":"<p><strong>Objective: </strong>The Woven EndoBridge (WEB; MicroVention TERUMO, Tustin, CA, USA) is an intrasaccular flow disruptor developed for the treatment of wide-neck bifurcation aneurysms (WNBA). While its safety and satisfactory mid- to long-term treatment outcomes have been documented, there have also been reports of complications such as WEB protrusion and migration. We encountered 3 cases in which the WEB protruded or migrated to the parent vessel after deployment, necessitating retrieval. In this report, we address the technical tips for retrieval techniques and factors associated with these complications, including a literature review.</p><p><strong>Case presentation: </strong>Of the 120 cases of our experience with WEB treatment for cerebral aneurysms for the period since January 2021, 3 required WEB retrievals. In 2 cases, significant WEB migration toward the parent vessel occurred while maneuvering the delivery microcatheter because of sticky detachment. In the remaining case, after detachment of the WEB, tilting occurred, leading to a strong protrusion into one of the branches, which prevented guiding the microcatheter for bailout stenting. In all cases, the proximal marker of the WEB was captured using an Amplatz Goose Neck Microsnare (Medtronic, Minneapolis, MN, USA) pulled back into the VIA catheter (the delivery catheter for the WEB; MicroVention TERUMO), and further into an intermediate catheter positioned as close to the aneurysm as possible, enabling uneventful retrieval.</p><p><strong>Conclusion: </strong>None of the cases damaged the aneurysm or proximal parent vessel wall, and additional aneurysm occlusion treatment was performed. However, WEB protrusions and migration are rare. When retrieval is required, it is crucial to act swiftly owing to the risk of distal thrombosis from the lumen inside of the WEB. Therefore, recognizing Goose Neck Microsnare as a retrieval technique is valuable.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onyx Liquid Embolic Agent: Basic Knowledge for Its Use in Interventional Neuroradiology.","authors":"Takao Kojima, Takuya Maeda, Yuhei Ito, Haruhiko Kikuta, Masazumi Fujii","doi":"10.5797/jnet.ra.2024-0073","DOIUrl":"10.5797/jnet.ra.2024-0073","url":null,"abstract":"<p><p>Onyx (Medtronic, Minneapolis, MN, USA) is a non-adhesive liquid embolic agent composed of an ethylene vinyl alcohol (EVOH) copolymer dissolved in dimethyl sulfoxide (DMSO). Onyx is explicitly designed for use in interventional neuroradiological procedures. Onyx's unique formulation allows controlled delivery and solidification within the target vessel, providing durable occlusion of abnormal vascular structures such as arteriovenous malformations and dural arteriovenous fistulas. This report reviews the basic understanding of the use of Onyx in interventional neuroradiology. The hydrophilic properties of the agent facilitate its smooth delivery through microcatheters, ensuring precise navigation and deposition within vascular malformations under fluoroscopic guidance. When Onyx was injected into the target vessel, the vessel was embolized as the solvent (DMSO) diffused into the blood and EVOH precipitated to form a durable cast. Onyx liquid embolic agents substantially advance the endovascular treatment of intracranial vascular lesions.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Thrombectomy for Cerebral Embolism after Transcatheter Aortic Valve Replacement: A Case Report.","authors":"Taiki Isaji, Yuto Takahashi, Hideo Hattori, Takayuki Amano","doi":"10.5797/jnet.cr.2024-0076","DOIUrl":"10.5797/jnet.cr.2024-0076","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral infarction is a major perioperative complication of transcatheter aortic valve replacement (TAVR). The number of patients undergoing TAVR has been increased annually. Therefore, neurosurgeons and neurologists who engage in stroke therapy, including mechanical thrombectomy (MT), may have more opportunities to treat stroke patients after TAVR in the future. We herein report a case of MT that was performed for cerebral infarction after TAVR.</p><p><strong>Case presentation: </strong>A 92-year-old woman presented with right upper extremity weakness 1 day after undergoing TAVR. On diffusion-weight MRI, most regions of the left middle cerebral artery (MCA) showed a high signal intensity due to the occlusion of the left MCA. She was diagnosed with cerebral infarction due to left M2 occlusion and underwent MT using a stent retrieval and aspiration device under proximal flow arrest using a balloon guide catheter. After thrombectomy, angiography revealed thrombolysis in cerebral infarction (TICI) 3 revascularization. Histopathological analysis of the retrieved embolus revealed vascular endothelial cells surrounding a portion of the tissue and an interstitium composed of fibrotic tissue without any atheromatous lesions. The embolus was believed to consist of part of the valve tissue because an atheromatous lesion was not formed in the valve tissue, and no smooth muscle-rich media were observed, unlike in the artery wall.</p><p><strong>Conclusion: </strong>Cerebral embolism after TAVR can be caused by emboli from valve tissue. In such cases, MT using a combined technique with proximal flow arrest may be effective.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transarterial Embolization for the Management of Brain Arteriovenous Malformations: A Systematic Review.","authors":"Kenichi Sato, Yasushi Matsumoto, Masayuki Ezura, Hidenori Endo","doi":"10.5797/jnet.ra.2024-0049","DOIUrl":"10.5797/jnet.ra.2024-0049","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed for a systematic review to clarify the current role of transarterial embolization (TAE) in the management of brain arteriovenous malformations (BAVMs).</p><p><strong>Methods: </strong>A search was conducted on PubMed, using the following terms; \"brain arteriovenous malformation,\" \"cerebral arteriovenous malformation,\" \"endovascular treatment,\" and \"transarterial embolization.\" Studies reporting the efficacy and safety of endovascular treatment for BAVMs, performed either as a standalone treatment or in conjunction with surgery or radiosurgery, were included. The final search was conducted in December 2023. Only articles written in English were reviewed. The references of publications of interest were also screened. Studies on transvenous embolization were excluded. More than 100 articles on the treatment of BAVMs were reviewed.</p><p><strong>Results: </strong>Advances in endovascular techniques and devices have enabled TAE as a treatment modality for BAVMs, to achieve higher embolization rates. Thus, curative TAE for some BAVMs with suitable angioarchitecture has become possible. The efficacy of presurgical TAE in the treatment of low Spetzler-Martin grade BAVMs is limited; however, TAE is effective for intermediate grade BAVMs. Several reports using propensity-matched analyses reevaluated the therapeutic efficacy of pre-/post-radiosurgical TAE for BAVMs with radiosurgery-resistant lesions such as large nidus, fistulous components, and associated aneurysms. The complication rate of TAEs as a treatment modality for BAVMs is approximately 10%, and hemorrhagic complications occur in approximately 5% of cases. Despite recent advances, substantial improvements have not been observed in the morbidity and mortality associated with TAEs for the treatment of BAVMs.</p><p><strong>Conclusion: </strong>TAE for the treatment of BAVMs is primarily performed in an adjuvant manner; however, recent advances have made standalone embolization possible. A multidisciplinary team should evaluate each case independently. Furthermore, as per recent studies, inclusive of meta-analyses, the efficacy and safety of TAEs for the treatment of BAVMs have not been elucidated. Thus, the manifestations and characteristics of BAVMs, in addition to the objective of performing a TAE, should be deliberated carefully before the endovascular procedure, to avoid complications.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor Embolization Using a Small-Bore Guide via the Distal Radial Artery Approach: Report of Five Consecutive Cases.","authors":"Satoshi Horiguchi, Yoshinori Maki, Takeshi Satow, Yuto Mitsuno, Kota Nakajima","doi":"10.5797/jnet.cr.2025-0008","DOIUrl":"10.5797/jnet.cr.2025-0008","url":null,"abstract":"<p><strong>Objective: </strong>Cardiologists use the distal radial artery (dRA) approach in daily clinical practice. This method is gradually being applied in neuroendovascular treatment. However, limited studies have been reported concerning tumor embolization using small-bore guidance via dRA.</p><p><strong>Case presentation: </strong>Five consecutive tumoral cases underwent endovascular embolization via the dRA approach. The right dRA was punctured, with manual confirmation of pulsation or under the guidance of ultrasonography, using a 22-G plastic cannulation needle. After the insertion of a 0.021-inch guidewire, a dilator of a 4-Fr sheath enlarged the puncture site. The 22-G plastic cannulation needle was replaced with an 18-G cannulation needle, and a 0.035 guidewire was inserted to introduce a small-bore guide. A TEMPO4 (Cordis, Miami Lakes, FL, USA; outer diameter: 1.35 mm) or a 3.6-Fr JB2 (Gadelius Medical, Tokyo, Japan; outer diameter: 1.2 mm) was used in 4 cases to convey embolization materials, whereas a 4-Fr, 16-cm sheath (Terumo, Tokyo, Japan; outer diameter: 2 mm) combined with a 4-Fr SY3 (Gadelius Medical; outer diameter: 1.4 mm) was used in 1 case. Trisacryl gelatin microspheres or <i>n</i>-butyl-2-cyanoacrylate were used as embolization materials. Hemostasis was achieved with PreludeSYNC DISTAL (Merit Medical, South Jordan, UT, USA), and the median time ± standard deviation of hemostasis was 2.00 ± 0.77 h. No complications occurred after embolization.</p><p><strong>Conclusion: </strong>Tumor embolization using small-bore guide via the dRA approach was completed without any complications.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Turn-Over Technique for Inserting and Stabilizing Guiding Sheath without Straightening It during Carotid Artery Stenting via Trans-Brachial Approach in Cases with Severe Vascular Access Conditions.","authors":"Yuki Kato, Kentaro Yamashita, Tomohiro Iida, Kodai Uematsu, Tatsuya Kuroda, Satoru Murase","doi":"10.5797/jnet.tn.2024-0017","DOIUrl":"10.5797/jnet.tn.2024-0017","url":null,"abstract":"<p><strong>Objective: </strong>In cases of severe atherosclerosis or tortuous arteries, inserting the guiding sheath into the target vessel is challenging. Here, we present the turn-over technique for inserting and stabilizing the guiding sheath without straightening it during carotid artery stenting (CAS).</p><p><strong>Case presentation: </strong>Two patients with severe left internal carotid artery stenosis underwent CAS via the trans-brachial approach. Although inserting the guiding sheath into the common carotid artery using conventional techniques was challenging, we succeeded in inserting it into the target vessel using the \"turn-over technique.\" At first, the guidewire was U-turned just above the aortic valve and inserted into the left external carotid artery. The inner catheter and guiding sheath were then followed along the guidewire to the left common carotid artery, and the guidewire and inner catheter were removed. The guiding sheath was stable in a U-turned position, and straightening the guiding sheath was difficult. Devices such as stents and balloons could be delivered without problems, and CAS was completed with the guiding sheath in a U-turned position.</p><p><strong>Conclusion: </strong>The turn-over technique for inserting and stabilizing the guiding sheath for CAS via the trans-brachial approach is an option in cases of difficult catheter access due to atherosclerosis or tortuous arteries.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"18 7","pages":"203-206"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11260518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single-Center Experience of Mechanical Thrombectomy for Cancer-Associated Ischemic Stroke.","authors":"Shunsuke Magami, Kouhei Yoshida, Yasuaki Nakao, Hidenori Oishi, Takuji Yamamoto","doi":"10.5797/jnet.oa.2023-0067","DOIUrl":"10.5797/jnet.oa.2023-0067","url":null,"abstract":"<p><strong>Objectives: </strong>Cancer-associated ischemic stroke tends to extend over multiple vascular territories and develops under poor general conditions. Owing to the rarity of such cases and poor prognoses, no comprehensive studies on mechanical thrombectomy for cancer-associated ischemic stroke have been reported in Japan. The present study investigated the radiological and clinical characteristics of mechanical thrombectomy in patients with cancer-associated ischemic stroke at our institution.</p><p><strong>Methods: </strong>We retrospectively reviewed 108 patients who underwent mechanical thrombectomy for large cerebral artery occlusion between January 1, 2021, and October 31, 2022, at our institution. The characteristics of mechanical thrombectomy in the cancer-associated ischemic stroke group were compared with those in the control group.</p><p><strong>Results: </strong>Of the 108 patients (112 procedures), seven patients (eight procedures) with clinically diagnosed cancer-associated ischemic stroke underwent mechanical thrombectomy. Of the eight procedures, six were performed during hospitalization. In contrast, only 10 of 104 procedures were performed in the control group. The in-hospital onset rate was higher in the cancer-associated ischemic stroke group (75.0%) compared to that in the controls (9.6%); <i>p</i> <0.001. The puncture-to-reperfusion time was significantly longer in the cancer-associated ischemic stroke group in comparison to that in the controls with a median interquartile range of 69 minutes (60.0-82.0 minutes) and 59.5 minutes (44.5-69.3 minutes), respectively (<i>p</i> <0.01). However, the rates of successful recanalization defined as thrombolysis in cerebral infarction ≥2b were not significantly different between the cancer-associated ischemic stroke group and controls with values of 62.5% and 79.8%, respectively (<i>p</i> = 0.250). Of the eight cases in the cancer-associated ischemic stroke group, only one (12.5%) had a good outcome on a modified Rankin Scale score of 0 to 2 at discharge, in contrast to 23 of the 104 (23.1%) cases in the controls (<i>p</i> = 0.523). Histopathological examination of six retrieved thrombi in the cancer-associated stroke group using hematoxylin and eosin staining revealed that only one case showed an erythrocyte-dominant thrombus while five displayed a fibrinoplatelet-dominant component. Conversely, 65 of 92 retrieved thrombi in the control group were erythrocyte dominant. Cancer was pathologically diagnosed in four of seven patients, all of which were adenocarcinomas.</p><p><strong>Conclusion: </strong>Cancer-associated ischemic stroke tends to occur during hospitalization. Coagulation disorders associated with cancer, especially adenocarcinoma, may be related to the formation of thrombi with fibrinoplatelet-dominant components, leading to ischemic stroke. The procedural time for mechanical thrombectomy in cancer-associated ischemic stroke tends to be longer.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"18 2","pages":"37-46"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10878738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle Meningeal Artery Embolization for Refractory Chronic Subdural Hematoma Associated with Acute Myeloid Leukemia: A Case Report.","authors":"Atsuhiro Kojima, Masataka Hosoi, Kanako Hayashi, Mariko Fukumura, Isako Saga","doi":"10.5797/jnet.cr.2023-0084","DOIUrl":"10.5797/jnet.cr.2023-0084","url":null,"abstract":"<p><strong>Objective: </strong>We describe a patient with leukemia-related chronic subdural hematoma (CSDH) who was successfully treated using the combination of surgical evacuation and middle meningeal artery (MMA) embolization.</p><p><strong>Case presentation: </strong>A 73-year-old man without apparent head trauma history was admitted to our hospital because of acute myeloid leukemia (AML). Head CT on admission revealed mild CSDH on both sides. Medical treatment options, including chemotherapy, were started. Since a decrease in platelet count and disseminated intravascular coagulation were observed on day 4, recombinant thrombomodulin was administered. As the patient exhibited signs of altered consciousness due to the enlargement of the right CSDH on day 10, we performed surgical drainage. Despite subsequent platelet transfusion and administration of goreisan, the right CSDH recurred within a short period. On day 17, we performed the second surgery and MMA embolization in one stage. The postoperative clinical course was favorable without recurrence of the hematoma. The patient eventually died on day 123 from a deterioration of his general condition.</p><p><strong>Conclusion: </strong>Although MMA embolization has recently been recognized as an effective treatment option for recurrent CSDH, there are no published reports addressing the efficacy of MMA embolization for refractory CSDH associated with hematological malignancies. Findings from the management of this case suggest that MMA embolization can be the effective treatment option for CSDH in patients with severe hemorrhagic diathesis due to AML.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"18 2","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10878736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}