scholarly journals Distal Access to Wide-Necked Aneurysms—‘Around the World’ Technique: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E39-E40
Author(s):  
Andrew J Ringer ◽  
Adam Arthur ◽  
Mark Bain ◽  
Bernard Bendock ◽  
Mandy Jo Binning ◽  
...  
Keyword(s):  
Cerebral Arteries ◽  
Balloon Catheter ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Gradual Onset ◽  
The World ◽  
The Wire ◽  
The Right ◽  
Wide Neck

Abstract Wide-necked aneurysms often pose challenges for distal access to the distal vasculature. This 64-yr-old woman without neurological deficits presented with atypical headaches of gradual onset. MRI revealed a large, symptomatic, unruptured carotid terminus aneurysm incorporating the origin of both the middle (MCA) and anterior cerebral arteries (ACA). Its wide neck created significant risks to coil prolapse and parent vessel compromise, risking stroke. With other options of higher risks, we recommended an around-the-world technique. Standard transfemoral access was used to the right internal carotid artery (ICA) with a 6F-Shuttle sheath and intracranial carotid with a 6F-Sofia distal access catheter. With dual-microcatheter access, 1 catheter was placed in the aneurysm dome, a second in the MCA for stent placement. Advancing the wire around the aneurysm first formed a loop from the lateral to medial wall for access to the MCA. The microcatheter was then advanced around the wire into the MCA, keeping the loop within the dome. With the loop's distal tip anchored, the distal end of the stent was deployed and anchored into the MCA. Both pitfalls (ie, lack of sufficient distal access, collapse of stent device during deployment) were resolved using a balloon catheter. With the balloon positioned and inflated as the anchor, the wire and catheter were pulled together. The loop in the aneurysm's dome straightened out across the neck, the stent was advanced into the MCA, and coiling proceeded. A large neck remnant had partially closed on 6-mo follow-up angiogram. Patient consented to undergo the procedure. Illustrations in video published/printed with permission from Mayfield Clinic.

Important Factors for a Combined Neurovascular Team to Consider in Selecting a Treatment Modality for Patients with Previously Clipped Residual and Recurrent Intracranial Aneurysms

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 732-739 ◽  
Author(s):  
Brian L. Hoh ◽  
Bob S. Carter ◽  
Christopher M. Putman ◽  
Christopher S. Ogilvy
Keyword(s):  
Endovascular Treatment ◽  
Treatment Modality ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Surgical Risk ◽  
Fatal Hemorrhage ◽  
The Mean ◽  
Selection Of

Abstract OBJECTIVE Intracranial residual and recurrent aneurysms can occur after surgical clipping, with risks of growth and rupture. In the past, surgical reoperation, which can be associated with higher risk than the initial operation, was the only available treatment. A combined neurovascular team that uses both surgical and endovascular therapies could maximize efficacy and outcomes while minimizing risks in these difficult cases. The indications for which surgical or endovascular treatment should be used to treat patients with residual or recurrent aneurysms, however, have not been elucidated well. We have reviewed the 10-year experience of our combined neurovascular team to determine in a retrospective manner which factors were important to treatment modality selection for patients with these residual and recurrent lesions. METHODS From 1991 to 2001, the combined neurovascular unit at the Massachusetts General Hospital treated 25 residual and recurrent previously clipped aneurysms (15 had been clipped at other centers). Only patients in whom a clip had been placed were included in the study; patients who did not have a clip placed or whose aneurysms were wrapped or coated were excluded. The radiographic studies and clinical data were reviewed retrospectively to determine the efficacy, outcomes, and factors important to the selection of treatment strategy in these patients. RESULTS The patients' clinical presentations were radiographic follow-up, 17 patients; rehemorrhage, 3; mass effect, 3; and thromboembolism, 2. The mean aneurysm recurrence or residual size was 11 mm (range, 4–26 mm). The mean interval until representation was 6.6 years (range, 1 wk–25 yr). Treatment consisted of: coiling, 11 patients; reclipping, 8; proximal parent vessel balloon occlusion, 2; extracranial-intracranial bypass with coil occlusion of aneurysm and parent vessel, 2; extracranial-intracranial bypass with clip trapping, 1; and extracranial-intracranial bypass with proximal clip occlusion of parent vessel, 1. The mean radiographic follow-up period was 11 months. Complete angiographic occlusion was found in 19 aneurysms (76%), at least 90% occlusion was found in 4 aneurysms (16%), intentional partial coil obliteration was found in 1 fusiform lesion (4%), and intentional retrograde flow was found in 1 fusiform lesion (4%). Clinical outcomes were excellent or good in 19 patients (76%). Twenty-one patients (84%) were neurologically the same after retreatment (13 remained neurologically intact, and 8 had preexisting neurological deficits that did not change). Three patients (12%) had new neurological deficits after retreatment, and one patient (4%) died. There were four complications of retreatment (16%), one of which was a fatal hemorrhage in a patient 1 month after intentional partial coil obliteration of a fusiform vertebrobasilar junction aneurysm. Factors important to the selection of treatment modality were recurrence or residual location (all posterior circulation lesions were treated endovascularly), lesion size (lesions larger than 10 mm were treated endovascularly or with the use of combined techniques), and aneurysm morphology (fusiform and wide-necked lesions were treated endovascularly or with the use of combined techniques). CONCLUSION The proper selection of surgical or endovascular treatment for residual and recurrent previously clipped aneurysms can achieve excellent radiographic efficacy with low mortality. Factors important to the selection of treatment by this combined neurovascular team were posterior circulation location, aneurysm size larger than 10 mm, and fusiform morphology, which were treated endovascularly or with the use of combined techniques because of the higher surgical risk associated with these factors. For aneurysms with lower surgical risk, such as some anterior circulation aneurysms and aneurysms smaller than 10 mm, we prefer to perform a reoperation because of superior radiographic cure without compromising the outcome.

scholarly journals Ischemic stroke with agraphestesia signal focus

2021 ◽  
Author(s):  
Ana Luísa Lopes Espínola da Costa Reis ◽  
Leonardo Henrique Gandolfi de Souza ◽  
Vitor Roberto Pugliesi Marques
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Parietal Lobe ◽  
Cerebral Arteries ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Ischemic Event ◽  
The Right ◽  
Sensory Ability

Introduction: The ischemic stroke is one of the main causes of death and disability in Brazil. Among the main risk factors are age, atrial fibrillation (AF), diabetes, dyslipidemia and physical inactivity. The main etiology of stroke is cardioembolic, resulting in obstruction of the cerebral arteries by a thrombus of cardiac origin. The artery most affected in ischemic strokes is the middle cerebral artery. The stroke has main characteristics, with emphasis on the sudden onset of symptoms, involvement of a focal area, ischemia caused by obstruction of a vessel and neurological deficits depending on the affected area. Graphesthesia is defined as a cutaneous sensory ability to recognize letters or numbers traced on the skin. The loss of this sensory ability is known as agraphesthesia. Case Report: M.A.F.O. female, 78a, arrived at the UPA complaining of mental confusion. Patient denies previous stroke. Personal history of systemic arterial hypertension. Upon physical examination, the patient was conscious, self and disoriented and inattentive. He was able to repeat and evoke words, without measurable motor déficits. Left upper limb with agraphestesia. Computed tomography was requested, which showed an extensive hypodense area in the right parietoccipital region, which leads to the erasure of the furrows between the adjacent gyres, which may correspond to a recent ischemic event. Magnetic resonance imaging, diffusion-restricted area with correspondence on the ADC map, located in the right temporoparietal region inferring an acute ischemic event. An electrocardiogram was also requested, which showed an irregular rhythm, characteristic of atrial fibrillation, resulting in a diagnostic hypothesis of cardioembolic ischemic stroke. Discussion: The involvement of post-central ischemic gyrus lesions may correspond to paresthesia, anesthesia, hypoesthesia; the involvement of secondary and terciary areas of sensitivity in the upper parietal lobe, especially in the active movements of the hand and in the modalities of integrated sensitivity, their lesions may be clinically affected by: apraxias, dysgraphias, hemineglect, agraphestesia, stereoagnosia and spacial disorientation.

Giant intracranial capillary hemangioma associated with enlarged head circumference in a newborn

2008 ◽  
Vol 1 (6) ◽  
pp. 488-492 ◽  
Author(s):  
Thomas Daenekindt ◽  
Frank Weyns ◽  
Kuan Hua Kho ◽  
Dieter Peuskens ◽  
Koen Engelborghs ◽  
...  
Keyword(s):  
Recent Literature ◽  
Endovascular Embolization ◽  
Capillary Hemangioma ◽  
Neurological Deficits ◽  
Conservative Approach ◽  
Temporal Fossa ◽  
Natural Behavior ◽  
Intracranial Lesion ◽  
The Right

✓ The authors describe the case of a patient with an intracranial capillary hemangioma, and they review the recent literature on intracranial capillary hemangiomas with special attention to their differential diagnosis and management. The only sign in this 7-week-old boy was head enlargement. There were no neurological deficits, and imaging revealed a large intracranial lesion in the right temporal fossa. The results of biopsy confirmed the diagnosis, and, after endovascular embolization, the entire lesion was resected. The incidence of intracranial capillary hemangioma is very low but may be underestimated. In the present case, the size of the tumor prompted surgical treatment. The natural behavior of extracranial capillary hemangiomas, however, suggests that a conservative approach with follow-up and steroid therapy may also be considered.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Republished: Monorail microsnare retrieval of cardiac microcatheter tip embolised to the middle cerebral artery after attempted cardiac ablation procedure

2020 ◽  
Vol 12 (7) ◽  
pp. e6-e6
Author(s):  
Michael Young ◽  
Ryan Johnson ◽  
Hamad Farhat
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Ablation Procedure ◽  
Cardiac Ablation ◽  
The Right

We present a case of a 52-year-old man with previous mitral valve replacement who presented to an outside hospital for planned cardiac ablation for atrial fibrillation. During the procedure, while advancing the microcatheter across the mitral valve, the microcatheter was sheared embolising into the right middle cerebral artery. This retained cardiac microcatheter tip was successfully retrieved with the monorail microsnare technique. The patient made a complete recovery without any neurological deficits or evidence of infarct on follow-up imaging.

Right ventricular aneurysm. Ectohic thymus in the right ventricle of fetal heart

2017 ◽  
Author(s):  
A.V. Makogon , I.V. Andrushina , D.A. Chernova
Keyword(s):  
Right Ventricular ◽  
Fetal Heart ◽  
Fetal Ultrasound ◽  
Aneurysm Wall ◽  
Thymus Tissue ◽  
Fetal Complications ◽  
The Right ◽  
Wide Neck ◽  
Made In

Objectives. The case of the right ventriclar aneurysm is presented. Pregnancy was terminated due to medical conditions. Autopsy was performed. Materials and Results. On carrying out the fetal ultrasound, a fingerlike protrusion with a wide neck, measuring 4  4 mm, was found in the right ventricular apex. There was pericardial effusion. The aneurysm wall was represented by the ectopic thymus tissue. Conclusions. Aneurysm and diverticulum of the fetal heart are dangerous disorders. The rate of fetal complications during pregnancy is high. The diagnosis of aneurysm/diverticulum may be made in the prenatal period. The prognosis of the survivors significantly differs between patients. Infants with no change in size of aneurysm/diverticulum had a normal development and no adverse events during follow-up. It is important to remember about different aetiology of fetal anomalies.

Diffuse cerebrovascular dilation: Case report of amezinium metilsulfate-induced reversible cerebral vasoconstriction syndrome

Cephalalgia ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 289-293 ◽  
Author(s):  
Makoto Kobayashi
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Case Description ◽  
Cerebral Vasoconstriction ◽  
Sympathomimetic Drug ◽  
Vasoactive Medications

Background Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches with reversible cerebral vasoconstriction, and often precipitated by the postpartum state and vasoactive medications. We describe a case of a patient with RCVS induced by amezinium metilsulfate, a sympathomimetic drug, in whom magnetic resonance angiography (MRA) initially revealed diffusely dilated cerebral arteries. Case description A 34-year-old woman was prescribed amezinium metilsulfate for hypotension. Twelve days later, she suffered from abrupt severe headaches and was referred to our department. She had no neurological deficits; however, MRA revealed diffusely dilated anterior, middle, and posterior cerebral arteries with vasoconstriction. She was tentatively diagnosed with RCVS and successfully treated with verapamil for headache. Nevertheless, follow-up MRAs disclosed widespread segmental vasoconstriction that resolved in two months. Discussion Diffuse cerebrovascular dilation has not been addressed but may be associated with RCVS pathophysiology. In addition, physicians should bear in mind that amezinium metilsulfate can potentially induce RCVS.

Intracranial Aneurysm Associated with Perianeurysmal Fat Tissue Lesion and Parenchymal Cystic Changes

2005 ◽  
Vol 18 (5-6) ◽  
pp. 575-580
Author(s):  
A. Cerase ◽  
I.M. Vallone ◽  
A. Atesalp ◽  
A. Demirci ◽  
C. Venturi ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Arterial Wall ◽  
Fat Tissue ◽  
Cerebral Vessel ◽  
Cystic Changes ◽  
Mechanisms Of Development ◽  
The Right ◽  
Wide Neck ◽  
Rule Out

The purpose of this report is to describe the seven-year clinical and neuroradiological follow-up of a perianeurysmal fatty lesion and perianeurysmal parenchymal cystic changes accompanying an asymptomatic unruptured wide-neck saccular aneurysm of the right middle cerebral artery trifurcation incidentally discovered in a 27-year-old male. The possible mechanisms of development are discussed. Notably, the close anatomical association between the two malformative lesions should rule out an incidental coexistence. Possible explanations include i) congenital structural deficiency of the cerebral vessel wall occurring at the same time of the formation of the fatty lesion, ii) fatty lesion inducing degeneration of the cerebral vessel wall possibly by limiting the nutrition of the smooth muscle cells, and iii) fatty lesion secreting some factors inducing weakness of the arterial wall to hemodynamic stress. Finally, both these lesion should lead to further impairment of perforating arteries resulting in areas of perianeurysmal encephalomalacia.

scholarly journals Biomechanical analysis of topspin techniques in table tennis games

MEDIKORA ◽  
2021 ◽  
Vol 20 (2) ◽  
pp. 125-133
Author(s):  
Aulia Gusdernawati ◽  
Widiyanto Widiyanto ◽  
Ahmad Nasrulloh
Keyword(s):  
Qualitative Research ◽  
Analysis Data ◽  
The Body ◽  
Biomechanical Analysis ◽  
Table Tennis ◽  
Male Athletes ◽  
Bending Angle ◽  
The World ◽  
The Right

Motion analysis in sports can help athletes and coaches as material for evaluating movement in improving movement and improving athlete performance with a predetermined training program. The purpose of this study was to analyze the motion of the topspin technique in table tennis. This research is a qualitative research by describing the results of the video analysis of the topspin technique movement which is accessed from youtube, then using the Kinovea application instrument. The subjects in this study were the top ranked players, which consisted of five of the best male athletes at the world level in the table tennis game. Based on the analysis data above, it was found that the average bending of the elbow at the ready position was 92.80, the swing position before hitting the ball was 142.40, when hitting the ball was 117.80, and after hitting the ball was 73.40. The results of the average elbow distance from the center point when the ready position is 68.728 cm, when the swing position before hitting the ball is 23.532 cm, when hitting the ball with a distance of 50.88 cm and during further motion 150.768 cm. The results of the analysis of the inclination angle of the body when the ready position is 161.60, when swinging the hand 152.60, when hitting the ball 150.60, and for further motion with a body inclination of 1660. The results of the analysis of the bending of the right leg when the position is 149.80, the position of swinging the right leg 125.40, and when the ball hits it forms an angle of 125.60 and when it continues to move 42.60. The average results of the analysis of the left leg bending angle when the ready position is 151.20, the swinging position with the left leg bending is 126.20, in the position of the ball hitting an angle of 130.40, and accompanied by a follow-up motion to form the left foot angle of 1460. The average foot distance when hitting the topspin, in the ready position is 186 cm, during the backswing the foot distance is 196.638 cm, and when hitting the ball is 198.81 cm, and accompanied by a follow-up motion of 195.886 cm. Biomechanical analysis of the topspin technique from several stages starting from the ready position to the advanced motion carried out by each athlete according to their respective body anatomy and following the position when hitting the ball.Analisis biomekanika teknik topspin pada permainan tenis mejaAbstrakAnalisis gerak pada olahraga dapat membantu atlet dan pelatih sebagai bahan evaluasi gerakan dalam memperbaiki gerakan dan meningkatkan performa atlet dengan program latihan yang telah ditentukan. Tujuan penelitian ini ialah menganalisis gerak teknik topspin dalam permainan tenis meja. Penelitian ini merupakan penelitian kualitatif dengan mendeskripsikan hasil analisis video gerakan teknik topspin yang diakses dari youtube, kemudian menggunakan instrumen aplikasi Kinovea. Subyek dalam penelitian ini men top ranked players yang berjumlah lima orang atlet putra terbaik ditingkat dunia pada permainan tenis meja. Berdasarkan dari data analisis diatas ditemukan nilai rerata tekukan siku pada saat posisi siap 92,80, posisi ayunan sebelum memukul bola 142,40, saat memukul bola 117,80, dan sesudah memukul bola sebesar 73,40. Hasil rerata jarak siku dari titik pusat saat posisi siap 68,728 cm, saat posisi ayunan sebelum memukul bola 23,532 cm, saat memukul bola dengan jarak 50,88 cm dan saat gerak lanjutan 150,768 cm. Hasil analisis sudut kecondongan tubuh saat posisi siap 161,60, saat mengayunkan tangan 152,60, saat memukul bola 150,60, dan untuk gerak lanjutan dengan kecondongan tubuh 1660. Hasil analisis tekukan kaki kanan saat posisi 149,80, posisi mengayunkan kaki kanan 125,40, dan saat perkenaan bola membentuk sudut 125,60 dan saat gerak lanjutan 42,60. Hasil rerata analisis sudut tekukan kaki kiri saat posisi siap 151,20, posisi mengayungkan tangan dengan tekukan kaki kiri 126,20, pada posisis perkenaan bola membentuk sudut 130,40, serta diiringi dengan gerak lanjutan membentuk sudut kaki kiri 1460. Hasil rerata jarak kaki saat melakukan pukulan topspin, pada posisi siap 186cm, saat backswing jarak kaki 196,638 cm, dan saat perkenaan bola 198,81 cm, serta di iringi gerak lanjutan 195,886 cm. Analisis biomekanik teknik topspin dari beberapa tahapan dimulai dari posisi siap hingga gerak lanjutan yang dilakukan masing-masing atlet sesuai anatomi tubuh masing-masing serta mengikuti posisi saat perkenaan bola.

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