Journal of cerebrovascular and endovascular neurosurgery最新文献

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Usefulness of sectional images in dural AVF for the interpretation of venous anatomy. 硬膜外动静脉瘘切面图像对解读静脉解剖的实用性。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-06-01 Epub Date: 2023-12-28 DOI: 10.7461/jcen.2023.E2022.10.001
Myongjin Kang, Sanghyeon Kim
{"title":"Usefulness of sectional images in dural AVF for the interpretation of venous anatomy.","authors":"Myongjin Kang, Sanghyeon Kim","doi":"10.7461/jcen.2023.E2022.10.001","DOIUrl":"10.7461/jcen.2023.E2022.10.001","url":null,"abstract":"<p><p>Knowledge of the venous anatomy is essential for appropriately treating dural arteriovenous fistulas (AVFs). It is challenging to determine the overall venous structure despite performing selective angiography for dural AVFs with feeder from multiple selected arteries. This is because only a part of the veins can be observed through the shunt in the selected artery. Therefore, after performing selective angiography of all vessels to understand the approximate venous anatomy, the venous anatomy can be easily understood by closely examining the source image of computed tomographic angiography or magnetic resonance angiography. Through this, it is possible to specify the vein that is to be blocked (target embolization), thereby avoiding extensive blocking of the vein and avoiding various complications. In the case of dural AVF with feeder from single selected artery, if the multiplanar reconstruction image of the three-dimensional rotational computed tomography obtained by performing angiography is analyzed thoroughly, a shunted pouch can be identified. If embolization is performed by targeting this area, unnecessary sinus total packing can be avoided.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"119-129"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050012","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}
引用次数: 0
Symptomatic perianeursymal cyst development 20 years after endovascular treatment of a ruptured giant aneurysm: Case report and updated review. 血管内治疗巨大动脉瘤破裂 20 年后出现症状性肛周囊肿:病例报告和最新综述。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-06-01 Epub Date: 2023-12-27 DOI: 10.7461/jcen.2023.E2023.02.001
Amy J Wang, Justin E Vranic, Robert W Regenhardt, Adam A Dmytriw, Christine K Lee, Cameron Sadegh, James D Rabinov, Christopher J Stapleton
{"title":"Symptomatic perianeursymal cyst development 20 years after endovascular treatment of a ruptured giant aneurysm: Case report and updated review.","authors":"Amy J Wang, Justin E Vranic, Robert W Regenhardt, Adam A Dmytriw, Christine K Lee, Cameron Sadegh, James D Rabinov, Christopher J Stapleton","doi":"10.7461/jcen.2023.E2023.02.001","DOIUrl":"10.7461/jcen.2023.E2023.02.001","url":null,"abstract":"<p><p>Perianeurysmal cysts are a rare and poorly understood finding in patients both with treated and untreated aneurysms. While the prior literature suggests that a minority of perianeurysmal cysts develop 1-4 years following endovascular aneurysm treatment, this updated review demonstrates that nearly half of perianeurysmal cysts were diagnosed following aneurysm coiling, with the other half diagnosed concurrently with an associated aneurysm prior to treatment. 64% of perianeurysmal cysts were surgically decompressed, with a 39% rate of recurrence requiring re-operation. We report a case of a 71-year-old woman who presented with vertigo and nausea and was found to have a 3.4 cm perianeurysmal cyst 20 years after initial endovascular coiling of a ruptured giant ophthalmic aneurysm. The cyst was treated with endoscopic fenestration followed by open fenestration upon recurrence. The case represents the longest latency from initial aneurysm treatment to cyst diagnosis reported in the literature and indicates that the diagnosis of perianeurysmal cyst should remain on the differential even decades after treatment. Based on a case discussion and updated literature review, this report highlights proposed etiologies of development and management strategies for a challenging lesion.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"187-195"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139041143","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}
引用次数: 0
The safety and efficacy of double microcatheter technique in small and tiny ruptured aneurysms: A single center study. 双微导管技术治疗微小破裂动脉瘤的安全性和有效性:一项单中心研究。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-06-01 Epub Date: 2023-10-31 DOI: 10.7461/jcen.2023.E2023.08.002
Hyeong Kyun Shim, Byung Jou Lee, Chae Heuck Lee, Moon Jun Sohn, Sook Young Shim, Chan Young Choi, Sung Rok Han, Kwang Hyeon Kim, Hae Won Koo
{"title":"The safety and efficacy of double microcatheter technique in small and tiny ruptured aneurysms: A single center study.","authors":"Hyeong Kyun Shim, Byung Jou Lee, Chae Heuck Lee, Moon Jun Sohn, Sook Young Shim, Chan Young Choi, Sung Rok Han, Kwang Hyeon Kim, Hae Won Koo","doi":"10.7461/jcen.2023.E2023.08.002","DOIUrl":"10.7461/jcen.2023.E2023.08.002","url":null,"abstract":"<p><strong>Objective: </strong>Double microcatheter technique (dMC) can be the alternative to Single microcatheter technique (sMC) for challenging cases, but there is lack of studies comparing dMC to sMC especifically for small ruptured aneurysms. Our objective was to compare the safety and efficacy of dMC to sMC in treating small (≤5 mm) and tiny (≤3 mm) ruptured aneurysms.</p><p><strong>Methods: </strong>This study focused on 91 out of 280 patients who had ruptured aneurysms and underwent either single or double microcatheter coil embolization. These patients were treated with either single or double microcatheter coil embolization. We divided the patients into two groups based on the procedural method and evaluated clinical features and outcomes. Subgroup analyses were conducted specifically for tiny aneurysms, comparing the two methods, and within the dMC group, we also examined whether the aneurysm was tiny or not. In addition, univariate logistic regression analysis was performed to assess the impact of coil packing density.</p><p><strong>Results: </strong>The mean values for most outcome measures in the dMC group were higher than those in the sMC group, but these differences did not reach statistical significance (coil packing density, 45.739% vs. 39.943%; procedural complication, 4.17% vs. 11.94%; recanalization, 8.3% vs. 10.45%; discharge discharge modified Rankin Scale (mRS), 1.83 vs. 1.97). The comparison between tiny aneurysms and other sizes within the dMC group did not reveal any significant differences in terms of worse outcomes or increased risk. The only factor that significantly influenced coil packing density in the univariate logistic regression analysis was the size of the aneurysm (OR 0.309, 95% CI 0.169-0.566, p=0.000).</p><p><strong>Conclusions: </strong>The dMC proved to be a safe and viable alternative to the sMC for treating small ruptured aneurysms in challenging cases.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"141-151"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430537","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}
引用次数: 0
Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report. 用端对端原位搭桥术治疗小脑后下动脉(PICA)动脉瘤破裂:病例报告。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-06-01 Epub Date: 2023-12-28 DOI: 10.7461/jcen.2023.E2023.05.006
Lívio Pereira de Macêdo, Delson Culembe Baptista-André, Arlindo Ugulino-Netto, Kauê Franke, Pierre Vansant Oliveira Eugênio, Auricélio Batista Cezar-Junior, Igor Vilela Faquini, Eduardo Vieira de Carvalho-Júnior, Nivaldo S Almeida, Hildo Rocha Cirne Azevedo-Filho
{"title":"Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report.","authors":"Lívio Pereira de Macêdo, Delson Culembe Baptista-André, Arlindo Ugulino-Netto, Kauê Franke, Pierre Vansant Oliveira Eugênio, Auricélio Batista Cezar-Junior, Igor Vilela Faquini, Eduardo Vieira de Carvalho-Júnior, Nivaldo S Almeida, Hildo Rocha Cirne Azevedo-Filho","doi":"10.7461/jcen.2023.E2023.05.006","DOIUrl":"10.7461/jcen.2023.E2023.05.006","url":null,"abstract":"<p><p>Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"216-222"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050011","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}
引用次数: 0
Coil embolization and recurrence of ruptured aneurysm originating from hyperplastic anterior choroidal artery. 源自增生性脉络膜前动脉的破裂动脉瘤的线圈栓塞和复发。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-06-01 Epub Date: 2023-10-10 DOI: 10.7461/jcen.2023.E2023.08.003
Susy Youn, Sang Kyu Park, Min Jeoung Kim
{"title":"Coil embolization and recurrence of ruptured aneurysm originating from hyperplastic anterior choroidal artery.","authors":"Susy Youn, Sang Kyu Park, Min Jeoung Kim","doi":"10.7461/jcen.2023.E2023.08.003","DOIUrl":"10.7461/jcen.2023.E2023.08.003","url":null,"abstract":"<p><p>Hyperplastic anterior choroidal artery (AchA) is an extremely rare congenital vascular variant that can be mistaken for other cerebral arteries. This case report presents a 38-year-old man who presented with a severe sudden-onset headache and was diagnosed with a ruptured aneurysm originating from a hyperplastic AchA. The aneurysm was successfully treated with coil embolization, but recurrence was detected after eight months, leading to additional surgical intervention. The discussion highlights the classification of hyperplastic AchA and emphasizes the importance of recognizing this anatomical variant to avoid complications during treatment. This case report underscores the need for awareness and understanding of hyperplastic AchA in the management of cerebral aneurysms.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"181-186"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184634","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}
引用次数: 0
Flow arrest during carotid artery stenting with a distal embolic protection device: A single-center experience and clinical implications. 使用远端栓塞保护装置进行颈动脉支架植入术时的血流阻滞:单中心经验及临床意义。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-06-01 Epub Date: 2024-02-26 DOI: 10.7461/jcen.2024.E2023.10.001
Noah Hong, Jeong-Mee Park, Seung Bin Kim, Young-Je Son
{"title":"Flow arrest during carotid artery stenting with a distal embolic protection device: A single-center experience and clinical implications.","authors":"Noah Hong, Jeong-Mee Park, Seung Bin Kim, Young-Je Son","doi":"10.7461/jcen.2024.E2023.10.001","DOIUrl":"10.7461/jcen.2024.E2023.10.001","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the incidence of flow arrest during carotid artery stenting (CAS) with filter-type embolic protection device (EPD), identify any predisposing factors for those situations, and contemplate intraprocedural precautionary steps.</p><p><strong>Methods: </strong>CAS was performed in 128 patients with 132 arteries using filter-type EPD. The characteristics of treated patients and arteries were compared between groups with and without flow arrest.</p><p><strong>Results: </strong>The incidence of flow arrest during CAS with filter-type EPD was 17.4%. In flow arrest group, cases of vulnerable plaques (p=0.02) and symptomatic lesions (p=0.01) were significantly more common, and there were more cases of debris captured by EPD in a planar pattern (p<0.01). Vulnerable plaques were significantly more common in the procedures showing a planar pattern than in the cases with other patterns (p<0.01). Flow arrest group showed a significantly higher rate of ischemic complications (p<0.05), although there were no significant periprocedural neurological changes. The planar pattern of captured debris in filter-type EPD was the only significant risk factor for flow arrest (adjusted odds ratio 88.44, 95% confidence interval 15.21-514.45, p<0.05).</p><p><strong>Conclusions: </strong>Flow arrest during CAS with filter-type EPD is not uncommon and associated with increased ischemic complications. Symptomatic stenoses and vulnerable plaque are related to this event. The planar pattern of captured debris on the EPD was the only significant risk factor for the flow arrest. Clinicians must pay attention to the occurrence of flow arrest and react quickly when performing CAS.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"163-173"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975152","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}
引用次数: 0
Internal maxillary artery (IMax) - middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report. 上颌内动脉-大脑中动脉旁路治疗双侧动脉粥样硬化性颈动脉闭塞1例技术病例报告。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-03-01 Epub Date: 2023-11-24 DOI: 10.7461/jcen.2023.E2022.11.003
Javier Degollado-García, Martin R Casas-Martínez, Bill Roy Ferrufino Mejia, Juan C Balcázar-Padrón, Héctor A Rodríguez-Rubio, Edgar Nathal
{"title":"Internal maxillary artery (IMax) - middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report.","authors":"Javier Degollado-García, Martin R Casas-Martínez, Bill Roy Ferrufino Mejia, Juan C Balcázar-Padrón, Héctor A Rodríguez-Rubio, Edgar Nathal","doi":"10.7461/jcen.2023.E2022.11.003","DOIUrl":"10.7461/jcen.2023.E2022.11.003","url":null,"abstract":"<p><p>Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"51-57"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300833","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}
引用次数: 0
Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations. 颅内动脉瘤血管内治疗后的影像随访策略:文献综述和指南建议。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-03-01 Epub Date: 2024-03-25 DOI: 10.7461/jcen.2024.E2023.08.008
Yong-Hwan Cho, Jaehyung Choi, Chae-Wook Huh, Chang Hyeun Kim, Chul Hoon Chang, Soon Chan Kwon, Young Woo Kim, Seung Hun Sheen, Sukh Que Park, Jun Kyeung Ko, Sung-Kon Ha, Hae Woong Jeong, Hyen Seung Kang
{"title":"Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations.","authors":"Yong-Hwan Cho, Jaehyung Choi, Chae-Wook Huh, Chang Hyeun Kim, Chul Hoon Chang, Soon Chan Kwon, Young Woo Kim, Seung Hun Sheen, Sukh Que Park, Jun Kyeung Ko, Sung-Kon Ha, Hae Woong Jeong, Hyen Seung Kang","doi":"10.7461/jcen.2024.E2023.08.008","DOIUrl":"10.7461/jcen.2024.E2023.08.008","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms.</p><p><strong>Methods: </strong>A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method.</p><p><strong>Results: </strong>The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3-5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence.</p><p><strong>Conclusions: </strong>The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140208723","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}
引用次数: 0
Transcranial Doppler emboli monitoring for stroke prevention after flow diverting stents. 经颅多普勒栓塞监测在引流支架术后预防脑卒中中的应用。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-03-01 Epub Date: 2023-10-10 DOI: 10.7461/jcen.2023.E2023.05.002
Matias Costa, Paul Schmitt, Jaleel N, Matias Baldoncini, Juan Vivanco-Suarez, Bipin Chaurasia, Colleen Douville, Loh Yince, Akshal Patel, Stephen Monteith
{"title":"Transcranial Doppler emboli monitoring for stroke prevention after flow diverting stents.","authors":"Matias Costa, Paul Schmitt, Jaleel N, Matias Baldoncini, Juan Vivanco-Suarez, Bipin Chaurasia, Colleen Douville, Loh Yince, Akshal Patel, Stephen Monteith","doi":"10.7461/jcen.2023.E2023.05.002","DOIUrl":"10.7461/jcen.2023.E2023.05.002","url":null,"abstract":"<p><strong>Objective: </strong>Flow diverting stents (FDS) are increasingly used for the treatment of intracranial aneurysms. While FDS can provide flow diversion of parent vessels, their high metal surface coverage can cause thromboembolism. Transcranial Doppler (TCD) emboli monitoring can be used to identify subclinical embolic phenomena after neurovascular procedures. Limited data exists regarding the use of TCDs for emboli monitoring in the periprocedural period after FDS placement. We evaluated the rate of positive TCDs microembolic signals and stroke after FDS deployment at our institution.</p><p><strong>Methods: </strong>We retrospectively evaluated 105 patients who underwent FDS treatment between 2012 and 2016 using the Pipeline stent (Medtronic, Minneapolis, MN, USA). Patients were pretreated with aspirin and clopidogrel. All patients were therapeutic on clopidogrel pre-operatively. TCD emboli monitoring was performed immediately after the procedure. Microembolic signals (mES) were classified as \"positive\" (<15 mES/hour) and \"strongly positive\" (>15 mES/hour). Clinical stroke rates were determined at 2-week and 6-month post-operatively.</p><p><strong>Results: </strong>A total of 132 intracranial aneurysms were treated in 105 patients. TCD emboli monitoring was \"positive\" in 11.4% (n=12) post-operatively and \"strongly positive\" in 4.8% (n=5). These positive cases were treated with heparin drips or modification of the antiplatelet regimen, and TCDs were repeated. Following medical management modifications, normalization of mES was achieved in 92% of cases. The overall stroke rates at 2-week and 6-months were 3.8% and 4.8%, respectively.</p><p><strong>Conclusions: </strong>TCD emboli monitoring may help early in the identification of thromboembolic events after flow diversion stenting. This allows for modification of medical therapy and, potentially, preventionf of escalation into post-operative strokes.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184636","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}
引用次数: 0
Reducing frame rate and pulse rate for routine diagnostic cerebral angiography: ALARA principles in practice. 降低常规诊断性脑血管造影的帧频和脉率:实践中的 ALARA 原则。
Journal of cerebrovascular and endovascular neurosurgery Pub Date : 2024-03-01 Epub Date: 2023-12-14 DOI: 10.7461/jcen.2023.E2023.01.007
Arvin R Wali, Sarath Pathuri, Michael G Brandel, Ryan W Sindewald, Brian R Hirshman, Javier A Bravo, Jeffrey A Steinberg, Scott E Olson, Jeffrey S Pannell, Alexander Khalessi, David Santiago-Dieppa
{"title":"Reducing frame rate and pulse rate for routine diagnostic cerebral angiography: ALARA principles in practice.","authors":"Arvin R Wali, Sarath Pathuri, Michael G Brandel, Ryan W Sindewald, Brian R Hirshman, Javier A Bravo, Jeffrey A Steinberg, Scott E Olson, Jeffrey S Pannell, Alexander Khalessi, David Santiago-Dieppa","doi":"10.7461/jcen.2023.E2023.01.007","DOIUrl":"10.7461/jcen.2023.E2023.01.007","url":null,"abstract":"<p><strong>Objective: </strong>Diagnostic cerebral angiograms (DCAs) are widely used in neurosurgery due to their high sensitivity and specificity to diagnose and characterize pathology using ionizing radiation. Eliminating unnecessary radiation is critical to reduce risk to patients, providers, and health care staff. We investigated if reducing pulse and frame rates during routine DCAs would decrease radiation burden without compromising image quality.</p><p><strong>Methods: </strong>We performed a retrospective review of prospectively acquired data after implementing a quality improvement protocol in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. Radiation doses and exposures were calculated. Two endovascular neurosurgeons reviewed randomly selected angiograms of both doses and blindly assessed their quality.</p><p><strong>Results: </strong>A total of 40 consecutive angiograms were retrospectively analyzed, 20 prior to the protocol change and 20 after. After the intervention, radiation dose, radiation per run, total exposure, and exposure per run were all significantly decreased even after adjustment for BMI (all p<0.05). On multivariable analysis, we identified a 46% decrease in total radiation dose and 39% decrease in exposure without compromising image quality or procedure time.</p><p><strong>Conclusions: </strong>We demonstrated that for routine DCAs, pulse rate of 7.5 with a frame rate of 4.0 is sufficient to obtain diagnostic information without compromising image quality or elongating procedure time. In the interest of patient, provider, and health care staff safety, we strongly encourage all interventionalists to be cognizant of radiation usage to avoid unnecessary radiation exposure and consequential health risks.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"46-50"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815380","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}
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