Republished: Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment

2016 ◽  
Vol 9 (4) ◽  
pp. e16-e16 ◽  
Author(s):  
Stefan Thomas Lang ◽  
Zarina Assis ◽  
John H Wong ◽  
William Morrish ◽  
Alim P Mitha
Keyword(s):  
Successful Treatment ◽  
Internal Carotid ◽  
Novel Device ◽  
First Case ◽  
Digital Subtraction Angiogram ◽  
Large Aneurysm ◽  
Delayed Growth ◽  
Flow Diverting Stent ◽  
Rapid Regrowth

A 62-year-old woman presented with a subarachnoid hemorrhage secondary to a ruptured right supraclinoid internal carotid artery blister aneurysm. She was treated in an emergent fashion with two flow diverting pipeline embolization devices (PED) deployed in a telescoping fashion. CT angiography performed for unrelated reasons at 7 months showed successful treatment of the aneurysm without evidence of residual aneurysm. However, a follow-up digital subtraction angiogram performed at 9 months showed a large aneurysm in a modified position compared with the original aneurysm. This is the first case of rapid regrowth of a supraclinoid blister aneurysm after successful treatment with a PED, and demonstrates the need for close follow-up for similar aneurysms treated with this novel device.

scholarly journals Regrowth of a Large Intracranial Aneurysm after On-Label Use of the Pipeline Embolization Device

2019 ◽  
Vol 10 (01) ◽  
pp. 142-144 ◽  
Author(s):  
Ching-Jen Chen ◽  
M. Rao Patibandla ◽  
Min S. Park ◽  
M. Yashar Kalani
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysm ◽  
Internal Carotid ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Residual Component ◽  
First Case ◽  
Aneurysm Occlusion

ABSTRACTDespite the widespread use of the pipeline embolization device (PED), no complete aneurysm regrowth after its placement has been reported in the literature. We report the first case of aneurysm regrowth after the initial follow-up angiography demonstrating near-complete occlusion of the aneurysm and remodeling of the vessel with on-label PED use for a large 20 mm × 24 mm × 22 mm (width × depth × height) cavernous segment internal carotid artery (ICA) aneurysm. The patient was treated with two overlapping PED (4.5 mm × 20 mm and 5 mm × 20 mm). Follow-up angiogram at 4 months after treatment demonstrated remodeling of the ICA with a small residual component measuring approximately 7 mm × 8 mm × 7 mm. However, at 10 months after treatment, there was a complete regrowth of the aneurysm with interval growth, now measuring 25 mm × 28 mm × 18 mm. Despite the high aneurysm occlusion rates reported with the PED, persistent aneurysm filling and aneurysm regrowth, although rare, should not be overlooked.

scholarly journals Novel use of flow diversion for the treatment of aneurysms associated with arteriovenous malformations

2017 ◽  
Vol 42 (6) ◽  
pp. E7 ◽  
Author(s):  
Craig Kilburg ◽  
Philipp Taussky ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Complete Occlusion ◽  
Martin Grade ◽  
Flow Diverting Stent

The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion. A 40-year-old woman presented with a history of headaches that led to the identification of an unruptured Spetzler-Martin Grade V, right parietooccipital AVM associated with 3 aneurysms of the ipsilateral internal carotid artery. Initial attempts at balloon-assisted coil embolization of the aneurysms were unsuccessful. The patient underwent placement of a flow-diverting stent across the diseased vessel; a 6-month follow-up angiogram demonstrated complete occlusion of the aneurysms. In the second case, a 57-year-old man presented with new-onset seizures, and an unruptured Spetzler-Martin Grade V, right frontal AVM associated with an irregular, wide-necked anterior communicating artery aneurysm was identified. The patient underwent placement of a flow-diverting stent, and complete occlusion of the aneurysm was observed on a 7-month follow-up angiogram. These 2 cases illustrate the potential for use of flow diversion as a treatment strategy for feeding artery aneurysms associated with AVMs. Because of the need for dual antiplatelet medications after flow diversion in this patient population, however, this strategy should be used judiciously.

scholarly journals Partial nephrectomy can be a successful treatment option for renal epithelioid angiomyolipoma: a case report and literature review

2020 ◽  
Vol 27 (1) ◽  
pp. 33-38
Author(s):  
Aurelija Liulytė ◽  
Algirdas Žalimas ◽  
Raimundas Meškauskas ◽  
Jurgita Ušinskienė ◽  
Feliksas Jankevičius
Keyword(s):  
Case Report ◽  
Partial Nephrectomy ◽  
Treatment Option ◽  
Successful Treatment ◽  
Left Kidney ◽  
Pathology Report ◽  
Epithelioid Angiomyolipoma ◽  
Rare Tumour ◽  
First Case

Background. Renal epithelioid angiomyolipoma is a rare tumour which involves kidneys in most cases. It is known for its aggressive behaviour as a significant number of cases have been associated with metastatic epithelioid angiomyolipoma. Usually, radical treatment with systemic therapy is recommended. Only a small number of cases of epithelioid angiomyolipomas have been reported with the standard treatment being radical or partial nephrectomy. We present a case report showing that partial nephrectomy can be a successful treatment option for renal epithelioid angiomyolipoma. This is the first case of this nature in Lithuania. Case presentation. In this case, a 40-year-old male with epithelioid angiomyolipoma of the left kidney is presented. In 2012, a cystic left renal mass 40 × 41 mm in size was diagnosed incidentally while performing ultrasound and later confirmed by MRI. Due to the size of the tumour and the possibility of renal cell carcinoma, surgery was scheduled. Left partial nephrectomy was performed successfully. Final pathology report came back with the diagnosis of renal epithelioid angiomyolipoma. The patient had yearly follow-up for six years by CT scan, and neither recurrence nor progression were observed. Conclusion. Early detection and diagnosis are crucial for treatment as the tumour tends to have malignancy potential. With early diagnosis, partial nephrectomy can be performed with yearly follow-up and no systemic treatment required.

scholarly journals Successful treatment of Takayasu’s arteritis in a HIV positive adult patient with long term follow up

2016 ◽  
Vol 3 (4) ◽  
pp. 14
Author(s):  
Marie DeLuca ◽  
Philip A. Gruppuso ◽  
Edward J. Wing
Keyword(s):  
Vertebral Artery ◽  
Successful Treatment ◽  
Takayasu’S Arteritis ◽  
Hiv Positive ◽  
Takayasu's Arteritis ◽  
Hiv Viral Load ◽  
First Case ◽  
Long Term Follow Up

Although vasculitides occur in patients with HIV, only 4 previous cases of Takayasu’s arteritis (TA) have been reported in HIVpatients. We describe the first case of TA in an HIV positive patient with successful treatment and long term follow up. A38-year-old woman who was HIV positive for the last 5 years on antiretroviral medications presented with increasing pain in herleft arm. Blood pressure and pulse were unrecordable in that arm. Laboratory testing revealed hemoglobin 7.9 g/dl, CRP 98.8 mg/L, CD4 675 cells/μl and HIV viral load < 48 copies/ml. Both MRA and standard angiography demonstrated occlusion of theleft subclavian artery from its origin to the vertebral artery where it was reconstituted via retrograde flow from the left vertebralartery and left carotid artery branches (subclavian steal). Narrowing of the vertebral artery was also noted. Treatment withprednisone and methotrexate for one year improved her symptoms and stabilized her lesions without infectious complications. Follow up 4 years after stopping therapy revealed mild symptoms and stable lesions on MRA.

scholarly journals Flow-diverting Stent-assisted Coil Embolization of a Ruptured Internal Carotid Artery Blister Aneurysm with the Pipeline Flex Embolization Device

2017 ◽  
Vol 08 (04) ◽  
pp. 664-667 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
Ayton Hope ◽  
Stefan Brew
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
High Grade ◽  
Parent Vessel ◽  
Future Studies ◽  
Aneurysm Neck ◽  
Flow Diverting Stent

ABSTRACTInternal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm. After removing the coiling microcatheter, the second PFED was telescoped into the first PFED. There were no postprocedural complications, and follow-up magnetic resonance angiography 15 months after embolization showed complete aneurysm obliteration. Flow-diverting stent-assisted coiling should be considered as a reconstructive, vessel-preserving, endovascular treatment option for appropriately selected patients with ruptured ICA blister aneurysms. However, future studies are necessary to assess the periprocedural safety in the setting of acute SAH.

scholarly journals Treatment of Telangiectasia Macularis Eruptiva Perstans with an Intense Pulsed Light Device

2018 ◽  
Vol 2 (4) ◽  
pp. 248-251
Author(s):  
William H Sipprell III ◽  
Harjot S Maan ◽  
Sherrif F Ibrahim
Keyword(s):  
Electron Beam ◽  
Successful Treatment ◽  
Intense Pulsed Light ◽  
Topical Steroids ◽  
Pulsed Light ◽  
Beam Radiation ◽  
Cutaneous Manifestations ◽  
Electron Beam Radiation ◽  
First Case

Telangiectasia macularis eruptiva perstans (TMEP) is a rare adult mastocytosis with prominent cutaneous manifestations including red to brown telangiectatic macules typically on the chest or limbs. TMEP can be a cause of morbidity with associated cutaneous findings (e.g. flushing, pruritus, ulcers) and extracutaneous symptoms (e.g. dyspnea, reflux, diarrhea, hypotension). Previous attempts to treat the cutaneous manifestations of TMEP include PUVA, topical steroids, electron beam radiation, and 585-nm flashlamp-pumped dye laser. We report the first case of successful treatment of the cutaneous findings of TMEP with intense pulsed light (IPL).  The patient underwent 2 treatments with IPL spaced 3 months apart, and remained entirely clear at 14 months follow-up. 

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

2020 ◽  
pp. 1-4
Author(s):  
Madeline B. Karsten ◽  
R. Michael Scott
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Internal Carotid ◽  
Imaging Finding ◽  
Neurological Status ◽  
Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

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