scholarly journals 5-French SOFIA: Safe Access and Support in the Anterior Cerebral Artery, Posterior Cerebral Artery, and Insular Middle Cerebral Artery

2018 ◽  
Vol 7 (6) ◽  
pp. 308-314 ◽  
Author(s):  
Bradley A. Gross ◽  
William J. Ares ◽  
Cynthia L. Kenmuir ◽  
Ashutosh P. Jadhav ◽  
Tudor G. Jovin ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Artery Aneurysm ◽  
Arteriovenous Shunt ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Case Type ◽  
Inner Diameter

Introduction: Distal access catheters are an infrequent focus of technical notes in neurointervention. The 5-French SOFIA’s unique design allows for compatibility with 6-French guide catheters, while its supple construction allows for remarkably distal access for a catheter with a 0.055-inch inner diameter. Methods: The authors reviewed a prospectively maintained endovascular database for cases utilizing the 5-French SOFIA from February 2017 through November 2017. Case type, SOFIA location, microcatheter used, and catheter-related complications were noted. Results: Over the evaluated period, the 5-French SOFIA was utilized in 33 cases, including 13 aneurysm treatments, 10 arteriovenous shunt embolizations, 5 stroke thrombectomies, and 5 other cases. Of 5 flow diversion cases, 1 was for a symptomatic cavernous internal carotid artery aneurysm necessitating transradial access, another for a ruptured A3 aneurysm, and another for a middle cerebral artery (M2) aneurysm; 2 were more proximal aneurysms. Thrombectomies were for M2 (n = 3) or A2 (n = 2) occlusions. In all cases, the 5-French SOFIA reached its anticipated distal target without complication or the need to utilize a smaller/alternative catheter. Of these 33 cases, there were 10 cases of distal SOFIA target locations: 6 M2/M3, 3 anterior cerebral arteries (ACA), and 1 posterior cerebral artery (PCA). M2/M3 and PCA catheterization was achieved over 2.1-Fr microcatheters; ACA catheterization employed a 2.9-Fr microcatheter for pipeline embolization and a deployed stentriever in the setting of two thrombectomies. Conclusion: The 5-French SOFIA can be safely utilized for distal, superselective catheterization in the context of complex neurointervention, including aneurysm and arteriovenous shunt embolization and distal thrombectomy.

Rupture of previously documented small asymptomatic saccular intracranial aneurysms

1992 ◽  
Vol 76 (6) ◽  
pp. 1019-1024 ◽  
Author(s):  
Wouter I. Schievink ◽  
David G. Piepgras ◽  
Fremont P. Wirth
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Careful Consideration ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Cerebellar Artery ◽  
Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

scholarly journals Extraction of a migrated coil from the Enterprise stent strut using a Solitaire AB stent

2016 ◽  
Vol 29 (6) ◽  
pp. 470-472
Author(s):  
Huijian Ge ◽  
Hengwei Jin ◽  
Youxiang Li ◽  
Xianli Lv
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Stent Strut ◽  
Distal Anterior Cerebral Artery ◽  
Neurologically Intact

A 56-year-old woman was admitted to stent-assisted coiling for a 2-mm A1 aneurysm of the left anterior cerebral artery and a left 3-mm internal carotid artery aneurysm. While coiling the A1 aneurysm, the first 2 mm × 20 mm coil migrated through the 4.5 mm × 37 mm Enterprise stent struts, lodging at the distal anterior cerebral artery. A 4 mm × 15 mm Solitaire AB stent was used successfully in this case to remove the displaced coil. The A1 aneurysm was re-treated with a 2 mm × 40 mm coil after placement of the Enterprise stent, and the ophthalmic ICA aneurysm was also coiled through the stent struts. The patient was neurologically intact after treatment.

Primary Epileptogenic Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1161-1165 ◽  
Author(s):  
Daniel Hänggi ◽  
Peter A. Winkler ◽  
Hans-Jakob Steiger
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Parahippocampal Gyrus ◽  
Anterior Communicating Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Cerebral Artery Aneurysm

Abstract BACKGROUND Seizures as the unique initial manifestation of unruptured intracranial aneurysms have rarely been documented and not systematically described until now. OBJECTIVE The purpose of this large retrospective analysis was to focus on the incidence of primary epileptogenic aneurysms and the influence of treatment on epilepsy. METHODS Within a 16-year period, 347 unruptured aneurysms were surgically treated at centers in Munich (1992–2002) and Düsseldorf (2003–2008), Germany. Of this patient population, 9 patients presented exclusively with epileptic seizures or epileptic equivalents. In 3 of them, a high-lying internal carotid artery aneurysm was diagnosed that was buried in the parahippocampal gyrus. In 4 patients, a middle cerebral artery aneurysm also created contact with the mediotemporal lobe adjacent to the parahippocampal gyrus. An anterior communicating artery aneurysm and a pericallosal artery aneurysm were diagnosed in 2 additional patients. Two patients with a middle cerebral artery aneurysm were initially incompletely occluded with Guglielmi detachable coils and continued to have epilepsy after the intervention. In all but 1 patient, the aneurysms were clipped and completely removed. RESULTS In all 8 patients operated on, there was no sign of hemorrhage intraoperatively but cortical gliosis was seen around the dome of the aneurysm. In all cases, the aneurysm and the surrounding gliosis, if existent, were surgically removed. Freedom from seizures without medication resulted for all patients after microsurgery. DISCUSSION Seizures as a presenting symptom of unruptured intracranial aneurysms are rare. There seems to be a preponderance of aneurysms anatomically related to the temporomedial region. Elimination of the aneurysm and perifocal gliosis provides the possibility of a cure for the epilepsy.

scholarly journals Territorial location of cerebral infarcts on imaging in patients with first ever stroke with diabetes

2014 ◽  
Vol 2 (1) ◽  
pp. 16-20
Author(s):  
Nirmalendu Bikash Bhowmik ◽  
Mohammad Saifuddin ◽  
Rajib Bhadra ◽  
Md Rashedul Islam ◽  
Rumana Habib ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Parietal Lobe ◽  
Posterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Arterial System ◽  
Peripheral Vascular ◽  
Cross Sectional ◽  
The Mean ◽  
First Time

Aims: The study was aimed to evaluate vascular territories of infarcts involved in patients with stroke for the first time with diabetes on CT and/ or MRI of brain. Methodology: This cross sectional descriptive study was carried on a total of 100 adult patients with first ever stroke consecutively reported in the Department of Neurology, BIRDEM General Hospital, Dhaka, over a period of six months. Results: The mean age was 61.45 years and majority (35%) belongs to age group of 50-59. Ten (10%) subjects had age above 80 years. Male were 68% and 32% were female. Majority (89%) of the subjects had hemiplegia following acute stroke. Aphasia (71%), headache (39%), convulsion (23%), vomiting (18%) and cranial nerve palsy (17%) were also found. Additional preexisting risk factors were hypertension (72%), dyslipidaemia (59%), smoking (56%) and alcohol abuse (2%). Among the study subjects the diabetic complications were peripheral vascular disease (4% ), neuropathy (8%), nephropathy( 9%)and retinopathy(25%). CT scan and/ or MRI brain showed parietal lobe lesion in 57% cases. Majority (76%) had infarcts in middle cerebral artery territory. Involvement of anterior and posterior cerebral artery territory was found in 7% and 5% subjects respectively. Vertebro-basilar arterial system involvement was observed in 6% cases. 4% subjects had involvement of both middle and posterior cerebral arteries. Both anterior and posterior arterial territory infarcts were found in 2% cases. Conclusions: In conclusion most of the diabetic subjects with first ever ischemic stroke had involvement of middle cerebral artery. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19951 Bangladesh Crit Care J March 2014; 2 (1): 16-20

scholarly journals Short Segment Internal Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Extracranial-to-Intracranial Bypass

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 804-809 ◽  
Author(s):  
Saleem I. Abdulrauf ◽  
Justin M. Sweeney ◽  
Yedathore S. Mohan ◽  
Sheri K. Palejwala
Keyword(s):  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Saphenous Vein Graft ◽  
Artery Aneurysm ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Short Segment ◽  
Internal Carotid Artery Aneurysm ◽  
Cervical Incision

Abstract BACKGROUND: Traditional high-flow extracranial-to-intracranial (EC-IC) bypass procedures require a cervical incision and a long (20–25 cm) radial artery or saphenous vein graft. This technical note describes a less invasive, EC-IC bypass technique using a short-segment (8–10 cm) of the radial artery to anastomose the internal maxillary artery (IMAX) to the middle cerebral artery. CLINICAL PRESENTATION: Anatomic dissections were performed on 6 cadaveric specimens to assess the location of the IMAX artery using an extradural middle fossa approach. Subsequently, the procedure was implemented in a patient with a giant fusiform internal carotid artery aneurysm. TECHNIQUE: A straight line was drawn anteriorly from the V2/V3 apex along the inferior edge of V2. The IMAX was found 8.6 mm on average anteriorly from the lateral edge of the foramen rotundum. We drilled to a depth of 4.2 mm on average to find the medial extent of the artery and then lateral and deep drilling exposed an average of 7.8 mm of graft. The IMAX was consistently found running just anterior and parallel to a line between the foramens rotundum and ovale. In the clinical case presented, both intraoperative indocyanine green and postoperative conventional angiography revealed a patent graft. The patient did well clinically without any new deficits. CONCLUSION: The advantages of this new technique include the avoidance of a long cervical incision and potentially higher patency rates secondary to shorter graft length than currently practiced.

Failure of Combined Treatment for the Thrombosed Posterior Cerebral Artery Aneurysm

2010 ◽  
Vol 38 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Yasuo MURAI ◽  
Koji ADACHI ◽  
Yoichi YOSHIDA ◽  
Akira TERAMOTO ◽  
Takayuki MIZUNARI
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Combined Treatment ◽  
Artery Aneurysm ◽  
Cerebral Artery Aneurysm
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