The effect of adenosine in inducing cardiac arrest for endovascular treatment of paediatric high-flow brain and spinal vascular malformation

Introduction Endovascular treatment of high-flow vascular lesions with onyx may be very dangerous due to premature occlusion of the vein resulting from high flow-induced migration of this embolic substance without occlusion of the feeding vessels and the nidus. It is also dangerous because of the risk of occlusion of the normal vessels around the lesion. Inducing temporary cardiac arrest using adenosine may be helpful in limiting and minimizing these risks. However anaesthetic management of this procedure in children suffering from high-flow vascular lesions is difficult and challenging. Methods We report three paediatric patients with high-flow cerebrospinal vascular lesions that underwent endovascular treatment under general anaesthesia and temporary cardiac arrest with adenosine. Adenosine was administered in escalating doses to induce a few seconds of cardiac standstill and the onyx injection was synchronized with the onset of adenosine-induced cardiac standstill, the fistula being occluded by onyx. Results There were no complications in peri-procedural treatment in all three cases. Post-embolization angiography revealed complete obliteration of the lesion, and the patients’ neurological status progressively improved at follow-up. Conclusion Adenosine-induced temporary cardiac standstill was successfully used to facilitate safe and controlled endovascular onyx embolization of high-flow central nervous system vascular lesions.

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Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

Journal of Neurosurgery ◽

10.3171/jns.1997.86.2.0211 ◽

1997 ◽

Vol 86 (2) ◽

pp. 211-219 ◽

Cited By ~ 156

Author(s):

Jean Raymond ◽

Daniel Roy ◽

Michel Bojanowski ◽

Robert Moumdjian ◽

Georges L'Espérance

Keyword(s):

Endovascular Treatment ◽

Clinical Results ◽

Aneurysm Rupture ◽

Content Type ◽

Unruptured Aneurysms ◽

Complete Obliteration ◽

Clinically Significant ◽

Technical Complication ◽

Fine Print

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

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Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12732 ◽

2013 ◽

Vol 19 (2) ◽

pp. 207-216 ◽

Cited By ~ 21

Author(s):

Won-Sang Cho ◽

Ki-Jeong Kim ◽

O-Ki Kwon ◽

Chi Heon Kim ◽

Jiha Kim ◽

...

Keyword(s):

Treatment Outcomes ◽

Clinical Outcomes ◽

Clinical Features ◽

Vascular Diseases ◽

Neurological Status ◽

Treatment Modalities ◽

Cure Rate ◽

Arteriovenous Fistulas ◽

Complete Obliteration

Object Spinal vascular diseases, such as spinal dural arteriovenous fistulas (DAVFs), perimedullary arteriovenous fistulas (AVFs), and spinal arteriovenous malformations (AVMs), are very rare. The authors analyzed the features and treatment outcomes of these conditions. Methods Data from 64 patients were retrospectively reviewed. There were 33 spinal DAVFs (1 patient had 2 lesions), 20 perimedullary AVFs, and 12 spinal AVMs. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated according to the diseases, subtypes, and treatment modalities. The median duration of follow-up was 20, 42, and 56 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively. Results Spinal DAVFs showed faster progression of symptoms (median 5, 12, and 36 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively) and worse neurological status at diagnosis (poor neurological status in 56%, 65%, and 33%, respectively). On MRI, signal voids were demonstrated in all except 1 spinal DAVF. At the last follow-up, 94% of spinal DAVFs, 68% of perimedullary AVFs, and 50% of spinal AVMs were completely obliterated. Favorable clinical outcomes were achieved in 91%, 95%, and 58%, respectively. In detail, the majority (78%) of spinal DAVFs were embolized, resulting in complete obliteration in 92% and favorable clinical outcomes in 92%. Most Type IVa and IVb perimedullary AVFs were surgically treated (71% and 88%), with complete obliterations of 86% and 71%, and favorable clinical outcomes in 100% and 86%, respectively. All Type IVc lesions were embolized with a low cure rate of 40%; however, clinical outcomes were satisfactory. Spinal AVMs were generally embolized (67%), and only glomus-type lesions attained a satisfactory cure rate (80%) and clinical outcome (100%). Conclusions Embolization produced satisfactory outcomes in spinal DAVFs and glomus-type spinal AVMs. Surgery is advantageous in Type IVa and IVb perimedullary AVFs. Palliative embolization can be effective in Type IVc perimedullary AVFs and juvenile spinal AVMs.

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Anatomical and Clinical Outcomes after Endovascular Treatment for Unruptured Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990200800406 ◽

2002 ◽

Vol 8 (4) ◽

pp. 367-376 ◽

Cited By ~ 11

Author(s):

B. J. Kwon ◽

M. H. Han ◽

C.W. Oh ◽

K. H. Kim ◽

K-H Chang

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Cerebral Aneurysms ◽

Neurological Status ◽

Neurological Deficits ◽

Anterior Circulation ◽

Unruptured Aneurysms ◽

Unruptured Cerebral Aneurysms ◽

Anatomical Outcomes

To describe the immediate and follow-up anatomical outcomes as well as procedure-related morbidity after endovascular procedures for unruptured cerebral aneurysms, we reviewed 68 patients with 78 unruptured aneurysms treated with detachable coils from may 1996 to february 2002. Angiograms were retrospectively reviewed for the nature of the aneurysms and the degree of therapeutic obliteration. Periprocedural complications, immediate clinical outcome and long-term neurological status were analyzed. Immediate anatomical outcomes were complete in 35 aneurysms (45%); residual neck in 24 (31%), partial contrast filling in 17 (22%), and failed embolization in two (2%). Of 27 aneurysms with follow-up angiography, 12 of the 13 aneurysms that were completely occluded in the initial treatment were still completely occluded at the end of a mean follow-up period of 17 months. Periprocedural complications were thromboembolic (n = 6), haemorrhagic (n = 3), coil protrusion (n = 7) and other unrelated complications (n = 3). Only two patients, with thromboembolic complications were moderately disabled with permanent neurological deficits in immediate clinical outcome, and their condition improved to independent in 1.5 and three months each. Small aneurysms and posterior circulation location showed more protective immediate results than aneurysms of large and anterior circulation after endovascular treatment (p values: 0.01 and 0.02). Our experiences of endovascular treatment for unruptured cerebral aneurysms were comparable to the results of recent series. Endovascular treatment for small posteriorly located aneurysms produced significantly better results than for large anteriorly located lesions.

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Microsurgery for Small Arteriovenous Malformations of the Brain: Results in 110 Consecutive Patients

Neurosurgery ◽

10.1097/00006123-200009000-00006 ◽

2000 ◽

Vol 47 (3) ◽

pp. 571-577 ◽

Cited By ~ 7

Author(s):

Justin H. T. Pik ◽

Michael K. Morgan

Keyword(s):

Arteriovenous Malformations ◽

Postoperative Outcome ◽

Neurological Status ◽

Acute Onset ◽

Neurological Deficits ◽

Vascular Lesions ◽

History Of ◽

The Brain ◽

Results Of Surgery

ABSTRACT OBJECTIVE To examine the results of surgery in 110 consecutive patients with arteriovenous malformations (AVMs) smaller than 3 cm in diameter. These results are compared with the published results of other microsurgical series as well as with results for patients treated with focused irradiation. METHODS From January 1989 to November 1998, 121 patients with AVMs smaller than 3 cm were treated at our institution. One hundred ten patients underwent microsurgical removal of their AVMs. The presentation, preoperative neurological status, and postoperative outcome were recorded. Follow-up was complete for all surgical cases. RESULTS Of the 110 patients, 109 (99%) had angiographically confirmed obliteration of their AVMs. Two patients (1.8%) required reoperation for residual AVM. Two (4.3%) of 46 patients with AVMs in eloquent brain areas experienced worsening of their neurological status after surgery. One (1.6%) of 64 patients was worse neurologically after removal of an AVM in a noneloquent area. CONCLUSION Microsurgical removal is a safe and effective treatment for the majority of AVMs smaller than 3 cm in diameter. Although the treatment is accompanied by a risk of acute onset of neurological deficits, this tends to be transient in the majority of cases. Furthermore, microsurgical excision of small AVMs offers patients immediate protection from the natural history of their vascular lesions.

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Endovascular treatment of intracranial microarteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.2008.109.12.1091 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1091-1097 ◽

Cited By ~ 25

Author(s):

Alexander Andreou ◽

Ioannis Ioannidis ◽

Shivendra Lalloo ◽

Nasis Nickolaos ◽

James V. Byrne

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Cerebral Angiography ◽

Intracerebral Hematoma ◽

Single Treatment ◽

Common Features ◽

Complete Obliteration ◽

Permanent Cure ◽

Brain Avms

Object Microarteriovenous malformations (micro-AVMs) are an uncommon subgroup of brain AVMs defined by a nidus measuring < 1 cm in diameter. The clinical features, angiographic characteristics, and outcomes in patients with micro-AVMs who had been treated endovascularly after presenting with hemorrhage were reviewed to identify common features affecting prognosis. Methods Between 1997 and 2006, 25 patients (12 females and 13 males) with 26 micro-AVMs were treated. Twenty-four patients presented with intracerebral hematoma and 1 with subarachnoid hemorrhage only. All patients underwent CT on admission, diagnostic cerebral angiography, and 1 session of endovascular treatment during the acute phase. Results Procedure-related complications occurred in 3 patients (12%), which caused temporary hemiparesis in 1 (4%) and no clinical sequelae in 2 patients (8%). Complete nidus obliteration was achieved at the end of the embolization in 22 (84.6%) of 26 lesions. Two recurrences were evident on follow-up angiography 6 months postembolization, resulting in a complete obliteration rate of 77% (20 of 26 lesions) after a single treatment. Late angiography was performed in 12 patients, and no further recurrences were identified. Conclusions Immediate complete obliteration of a micro-AVM with a high permanent cure and low morbidity rates was accomplished using endovascular treatment. Early embolization after bleeding should be considered as an alternative to resection.

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Surgical Dissection of a Perimedullary Fistula of Conus Medullaris With Long-Term Follow-Up: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy346 ◽

2018 ◽

Vol 17 (2) ◽

pp. E59-E59 ◽

Cited By ~ 1

Author(s):

Thomas J Sorenson ◽

Giuseppe Lanzino

Keyword(s):

Surgical Excision ◽

Vascular Supply ◽

Conus Medullaris ◽

Endovascular Embolization ◽

Neurological Deficits ◽

Vascular Lesions ◽

Complete Obliteration ◽

Long Term Follow Up ◽

Clinical And Radiological Outcome

Abstract Perimedullary fistulae of the spinal cord are rare vascular lesions that can present with different clinical patterns: hemorrhage, progressive myelopathy due to arterial steal and/or venous congestion, or symptoms due to compression of neural structures by engorged vessels. Treatment consists of surgical excision, endovascular embolization, or a combination of the two. If complete obliteration of the nidus exposes the patient to undue risk of permanent neurological deficits, incomplete obliteration with reduction of the vascular supply is a reasonable compromise to improve clinical symptomatology. Partial devascularization may also alter the natural history by decreasing the risk of further growth and bleeding. In this video we illustrate the case of a patient with a perimedullary fistula of the conus treated with surgical disconnection of the main fistulous component. Partial devascularization resulted in resolution of MRI signal changes and symptoms with documented good clinical and radiological outcome and progressive regression of the residual nidus over six years of follow-up.

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Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000376 ◽

2020 ◽

Vol 5 (3) ◽

pp. 291-301

Author(s):

Yisen Zhang ◽

Zhongbin Tian ◽

Wei Zhu ◽

Jian Liu ◽

Yang Wang ◽

...

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Treatment Algorithm ◽

High Volume ◽

Single Stage ◽

Treatment Modalities ◽

Complete Obliteration ◽

Aneurysm Growth

BackgroundThe management of bilateral intracranial vertebral artery dissecting aneurysms (IVADAs) is controversial, and requires the development of endovascular treatment modalities and principles. We aim to investigate the endovascular treatment strategy and outcomes of bilateral IVADAs.MethodsWe identified all bilateral IVADAs at a high-volume neurointerventional centre over a 10-year period (from January 2009 to December 2018). Radiographic and clinical data were recorded, and a treatment algorithm was derived.ResultsTwenty-seven patients with bilateral IVADAs (54 IVADAs in total, 51 unruptured, 3 ruptured) were diagnosed. Four patients (14.8%) received single-stage endovascular treatment, 12 patients (44.4%) with staged endovascular treatment and 11 patients (40.8%) with unilateral endovascular treatment of bilateral IVADAs. Thirty-six IVADAs (85.7%) have complete obliteration at the follow-up angiography. Two of three ruptured IVADAs with stent-assisted coiling recanalised, and had further recoiling. Three patients (11.1%) have intraprocedural or postprocedural complications (two in single-stage and one in staged). Twenty-five patients (92.6%) had a favourable clinical outcome, and two patients (7.4%, all in single-stage) showed an unfavourable clinical outcome at follow-up. For the patients with unilateral reconstructive endovascular treatment, the contralateral untreated IVADAs were stable and had no growth or ruptured during follow-up period. None of all IVADAs had rebleeding during the clinical follow-up.ConclusionsEndovascular treatment can be performed in bilateral IVADAs with high technical success, high complete obliteration rates and acceptable morbidity/mortality. Contralateral IVADAs had low rates of aneurysm growth and haemorrhage when treated in a staged/delayed fashion.

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Hypofractionated Conformal Stereotactic Radiotherapy for Arteriovenous Malformations

Neurosurgery ◽

10.1227/01.neu.0000088566.82699.e6 ◽

2003 ◽

Vol 53 (5) ◽

pp. 1036-1043 ◽

Cited By ~ 47

Author(s):

Peter Lindvall ◽

Per Bergström ◽

Per-Olov Löfroth ◽

Marwan I. Hariz ◽

Roger Henriksson ◽

...

Keyword(s):

Stereotactic Radiotherapy ◽

Arteriovenous Malformations ◽

University Hospital ◽

Vascular Lesions ◽

High Morbidity ◽

Single Fraction ◽

Eloquent Areas ◽

Complete Obliteration ◽

Cerebral Avms

Abstract OBJECTIVE Arteriovenous malformations (AVMs) are congenital vascular lesions that are associated with high morbidity and mortality if left untreated. There are several options for treatment, including radiotherapy. Safe and effective single-fraction radiotherapy for patients with large AVMs has been considered difficult. METHODS Between December 1986 and June 2001, 36 patients with cerebral AVMs were treated with hypofractionated conformal stereotactic radiotherapy at Umeå University Hospital. Twenty-nine patients have been followed angiographically to date and are reported in this study. RESULTS Twenty-four (83%) of 29 patients (mean AVM volume, 11.5 cm3) underwent complete obliteration of their AVMs. The rates of angiographically verified total obliteration at 2 years after treatment were 56% for AVMs 4 to 10 cm3 and 50% for AVMs larger than 10 cm3. The obliteration rate increased considerably with extended follow-up. Five years after treatment, the obliteration rates were 81% for AVMs 4 to 10 cm3 and 70% for AVMs larger than 10 cm3. CONCLUSION Hypofractionated conformal stereotactic radiotherapy may be an important alternative to single-fraction radiotherapy in patients with large AVMs or AVMs located in eloquent areas, because it allows the administration of a higher radiation dose than is possible to deliver in single-fraction radiosurgery. With our technique of hypofractionated conformal stereotactic radiotherapy, the rate of obliterating AVMs was comparable to that of single-dose radiosurgery, although the volumes of the irradiated AVMs in our study were larger than those reported previously.

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Jailed double-microcatheter technique following horizontal stenting for coil embolization of intracranial wide-necked bifurcation aneurysms: A technical report of two cases

Interventional Neuroradiology ◽

10.1177/1591019916685080 ◽

2017 ◽

Vol 23 (2) ◽

pp. 117-122 ◽

Cited By ~ 4

Author(s):

Takahiro Kitahara ◽

Taketo Hatano ◽

Makoto Hayase ◽

Etsuko Hattori ◽

Akinori Miyakoshi ◽

...

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Internal Carotid ◽

Treatment Results ◽

Technical Report ◽

Complete Obliteration ◽

One Year ◽

The One ◽

Additional Coil

The horizontal stenting technique facilitates endovascular treatment of wide-necked bifurcation intracranial aneurysms. Previous literature shows, however, that subsequent coil embolization at initial treatment results in incomplete obliteration in many cases. The authors present two consecutive cases of wide-necked large bifurcation aneurysms to describe an additional coil embolization technique following horizontal stenting. The patients were a 53-year-old female with an unruptured internal carotid artery terminus aneurysm and a 57-year-old female with a recurrent basilar artery tip aneurysm. Both patients underwent endovascular treatment with horizontal stenting followed by coil embolization with jailed double-microcatheters. Immediate complete obliteration was achieved with no complications, and no recanalization was observed at the one-year follow-up in both cases. Coil embolization with jailed double-microcatheter technique following horizontal stenting is a safe and effective strategy for wide-necked bifurcation aneurysms.

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Abstract 352: Predictive Value of Discharge Neurological Outcome Scores Following Out-of-Hospital Cardiac Arrest for Long-term Neurological Status: A Systematic Review

Circulation ◽

10.1161/circ.138.suppl_2.352 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Wen Yu Wu ◽

Amit Chopra ◽

Shelley McLeod ◽

Carolyn Ziegler ◽

Steve Lin

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Neurological Outcome ◽

Observational Studies ◽

Neurological Status ◽

Short Term ◽

Outcome Scores ◽

Hospital Cardiac Arrest

Introduction: Neurological outcomes following out-of-hospital cardiac arrest are commonly assessed using clinically validated outcome measures such as the Cerebral Performance Category (CPC) score, and are mainstay for evaluating neurological status at discharge. However, it remains unclear if these measures accurately reflect long-term neurological status after discharge. The primary objective of this systematic review was to better understand the predictive value of discharge neurological outcome scores for long-term neurological status. Methods: Comprehensive electronic searches of Medline, Embase and The Cochrane Library from inception to September 2016 were conducted and reference lists were hand-searched.Randomized controlled trials (RCT) and prospective observational studies were included. Our primary outcome was the correlation between discharge or 30 days post-arrest neurologic status and long-term ( > 3 month) neurological outcome score. Preliminary Results: After screening 4,265 titles and abstracts independently and in duplicate, 6 studies including 5 prospective observational studies and 1 RCT were included. Four studies reported long-term follow-up at 6 months post-arrest and 2 studies reported follow-up at 1 year. In the studies with 6-month follow-up, 368/450 patients (82.7%) had favourable short-term neurological scores (CPC 1-2) at discharge or 30 days post-arrest, and 352/445 patients (79.1%) had favourable scores at 6 months post-arrest. In the studies with 1-year follow-up, 67/80 patients (83.8%) had favourable neurological scores at discharge or 30 days post-arrest, and 60/80 patients (75%) patients had favourable neurological scores at 1 year. Conclusion: Long-term neurological outcome scores following OHCA were consistent with short-term outcome at hospital discharge or 30 days post-arrest. Further studies are needed to elucidate more comprehensive prognostic factors for predicting long-term neurological outcome.

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