Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience

2000 ◽  
Vol 92 (5) ◽  
pp. 771-778 ◽  
Author(s):  
Peter A. Rasmussen ◽  
John Perl ◽  
John D. Barr ◽  
Georges Z. Markarian ◽  
Irene Katzan ◽  
...  
Keyword(s):  
Alternative Therapy ◽  
Signs And Symptoms ◽  
Antiplatelet Agents ◽  
Posterior Circulation ◽  
Occlusive Disease ◽  
Stent Insertion ◽  
Initial Experience ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty.Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure.The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively.Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

Transient neurological deficits secondary to saccular vertebrobasilar aneurysms

1984 ◽  
Vol 60 (2) ◽  
pp. 410-413 ◽  
Author(s):  
Abe Steinberger ◽  
S. Ramaiah Ganti ◽  
James G. McMurtry ◽  
Sadek K. Hilal
Keyword(s):  
Posterior Circulation ◽  
Neurological Deficits ◽  
Transient Ischemic Attacks ◽  
Anterior Circulation ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Posterior Circulation Aneurysm ◽  
Vertebrobasilar Aneurysms ◽  
Possible Cause ◽  
Fine Print

✓ Aneurysms have rarely been implicated as a possible cause of transient neurological deficits, and most reports of this phenomenon describe aneurysms in the anterior circulation. There is only one previous report of a saccular posterior circulation aneurysm associated with transient ischemic attacks. The authors document two cases of giant saccular vertebrobasilar artery aneurysms associated with transient neurological deficits.

Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement

2003 ◽  
Vol 98 (5) ◽  
pp. 1045-1055 ◽  
Author(s):  
Brian K. Owler ◽  
Geoffrey Parker ◽  
G. Michael Halmagyi ◽  
Victoria G. Dunne ◽  
Verity Grinnell ◽  
...  
Keyword(s):  
Stent Placement ◽  
Pseudotumor Cerebri ◽  
Venous Sinus ◽  
Stent Insertion ◽  
Benign Intracranial Hypertension ◽  
Content Type ◽  
Venous Sinuses ◽  
Pseudotumor Cerebri Syndrome ◽  
New Treatment ◽  
Fine Print

Object. Pseudotumor cerebri, or benign intracranial hypertension, is a condition of raised intracranial pressure in the absence of a mass lesion or cerebral edema. It is characterized by headache and visual deterioration that may culminate in blindness. Pseudotumor cerebri is caused by venous sinus obstruction in an unknown percentage of cases. The purpose of this study was to investigate the role of cerebral venous sinus disease in pseudotumor cerebri and the potential of endoluminal venous sinus stent placement as a new treatment. Methods. Nine consecutive patients in whom diagnoses of pseudotumor cerebri had been made underwent examination with direct retrograde cerebral venography (DRCV) and manometry to characterize the morphological features and venous pressures in their cerebral venous sinuses. The cerebrospinal fluid (CSF) pressure was measured simultaneously in two patients. If patients had an amenable lesion they were treated using an endoluminal venous sinus stent. Five patients demonstrated morphological obstruction of the venous transverse sinuses (TSs). All lesions were associated with a distinct pressure gradient and raised proximal venous sinus pressures. Four patients underwent stent insertion in the venous sinuses and reported that their headaches improved immediately after the procedure and remained so at 6 months. Vision was improved in three patients, whereas it remained poor in one despite normalized CSF pressures. Conclusions. Patients with pseudotumor cerebri should be evaluated with DRCV and manometry because venous TS obstruction is probably more common than is currently appreciated. In patients with a lesion of the venous sinuses, treatment with an endoluminal venous sinus stent is a viable alternative for amenable lesions.

Characteristics and use of ultra-long aneurysm clips

1984 ◽  
Vol 60 (1) ◽  
pp. 145-150 ◽  
Author(s):  
Kenichiro Sugita ◽  
Shigeaki Kobayashi ◽  
Toshiki Inoue ◽  
Toshiki Takemae
Keyword(s):  
Content Type ◽  
Giant Aneurysms ◽  
Vertebrobasilar Artery ◽  
Fine Print

✓ Ultra-long aneurysm clips, 21 to 40 mm in length, are described, and their characteristics and application delineated. These clips have been used in 30 procedures for various kinds of aneurysms. They are useful not only for wide-necked and giant aneurysms but also for deeply located aneurysms such as those on the vertebrobasilar artery.

Diagnosis and management of pituitary abscess: a review of twenty-four cases

2001 ◽  
Vol 95 (2) ◽  
pp. 233-241 ◽  
Author(s):  
G. Edward Vates ◽  
Mitchel S. Berger ◽  
Charles B. Wilson
Keyword(s):  
San Francisco ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Signs And Symptoms ◽  
Cystic Mass ◽  
Pituitary Abscess ◽  
Pituitary Mass ◽  
Content Type ◽  
Visual Changes ◽  
Fine Print

Object. Pituitary abscess is a rare but serious intrasellar infection. To better determine the salient signs and symptoms that help in making the diagnosis, and to determine the most appropriate treatment, the authors reviewed their experience in a series of 24 patients treated at the University of California at San Francisco. Methods. Nine of the patients were female and 15 were male, and their mean age was 41.2 years (range 12–71 years). Surprisingly, most patients in our series presented with complaints and physical findings consistent with a pituitary mass, but rarely with evidence of a serious infection. Headache, endocrine abnormalities, and visual changes were the most common clinical indicators; fever, peripheral leukocytosis, and meningismus were present in 33% or fewer of the patients. Imaging tests demonstrated a pituitary mass in all patients, but the features evident on computerized tomography and magnetic resonance studies did not distinguish pituitary abscesses from other, more common intrasellar lesions. Because of the ambiguous clinical features and imaging findings, most abscesses were not diagnosed before treatment; rather, the diagnosis was made during surgical exploration of the sella turcica, when the surgeon encountered a cystic mass containing pus. There were only two deaths in this series (8.3%). Patients presenting with headache and visual changes noted improvement in almost all cases; patients with endocrine dysfunction generally did not recover normal pituitary function, but were easily treated with hormone replacement therapy. Conclusions. Antibiotic therapy is suggested for patients who have symptoms of sepsis, or for patients in whom specific organisms are identified from cultures obtained during surgery. The transsphenoidal approach is recommended over open craniotomy for surgical drainage.

Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms

2003 ◽  
Vol 98 (3) ◽  
pp. 529-535 ◽  
Author(s):  
Jose F. Alén ◽  
Alfonso Lagares ◽  
Ramiro D. Lobato ◽  
Pedro A. Gómez ◽  
Juan J. Rivas ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Clinical Syndrome ◽  
Posterior Circulation ◽  
Ct Scans ◽  
World Federation ◽  
Content Type ◽  
Unenhanced Ct ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

Object. Some authors have questioned the need to perform cerebral angiography in patients presenting with a benign clinical picture and a perimesencephalic pattern of subarachnoid hemorrhage (SAH) on initial computerized tomography (CT) scans, because the low probability of finding an aneurysm does not justify exposing patients to the risks of angiography. It has been stated, however, that ruptured posterior circulation aneurysms may present with a perimesencephalic SAH pattern in up to 10% of cases. The aim of the present study was twofold: to define the frequency of the perimesencephalic SAH pattern in the setting of ruptured posterior fossa aneurysms, and to determine whether this clinical syndrome and pattern of bleeding could be reliably and definitely distinguished from that of aneurysmal SAH. Methods. Twenty-eight patients with ruptured posterior circulation aneurysms and 44 with nonaneurysmal perimesencephalic SAH were selected from a series of 408 consecutive patients with spontaneous SAH admitted to the authors' institution. The admission unenhanced CT scans were evaluated by a neuroradiologist in a blinded fashion and classified as revealing a perimesencephalic SAH or a nonperimesencephalic pattern of bleeding. Of the 28 patients with posterior circulation aneurysms, five whose grade was I according to the World Federation of Neurosurgical Societies scale were classified as having a perimesencephalic SAH pattern on the initial CT scan. The data show that the likelihood of finding an aneurysm on angiographic studies obtained in a patient with a perimesencephalic SAH pattern is 8.9%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 16.6% of cases. Conclusions. This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH. In addition, the authors believe that there is no specific clinical syndrome that can differentiate patients who have a perimesencephalic SAH pattern caused by an aneurysm from those without aneurysms. Digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans.

Management of proximal shunt obstruction

1988 ◽  
Vol 68 (5) ◽  
pp. 817-819 ◽  
Author(s):  
Charles C. Duncan
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Intracranial Pressure ◽  
Signs And Symptoms ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Obstruction ◽  
Fine Print

✓ Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients with such obstruction by cannulation of the reservoir and ventricular catheter to penetrate into the ventricle with a 3½-in. No. 22 spinal needle. The findings in 20 cases in which this approach was utilized are summarized.

Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures

1975 ◽  
Vol 43 (4) ◽  
pp. 476-480 ◽  
Author(s):  
S. Walton Parry ◽  
John F. Schuhmacher ◽  
Raeburn C. Llewellyn
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Signs And Symptoms ◽  
Late Complications ◽  
Neurological Symptoms ◽  
Shunt Malfunction ◽  
Content Type ◽  
Ventriculoperitoneal Shunts ◽  
Ascites Formation ◽  
Fine Print

✓The authors report three patients with abdominal pseudocysts and one with cerebrospinal fluid ascites as late complications of ventriculoperitoneal shunts. The presenting signs and symptoms were those of an intraabdominal abnormality, with no neurological symptoms suggestive of shunt malfunction.

Detachable balloon embolization therapy of posterior circulation intracranial aneurysms

1989 ◽  
Vol 71 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima ◽  
Yoshifumi Konishi
Keyword(s):  
Basilar Artery ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Content Type ◽  
Aneurysm Neck ◽  
Balloon Embolization ◽  
Fine Print

✓ Treatment of complex and surgically difficult intracranial aneurysms of the posterior circulation is now being performed with intravascular detachable balloon embolization techniques. The procedure is carried out under local anesthesia from a transfemoral arterial approach, which allows continuous neurological monitoring. Under fluoroscopic guidance, the balloon is propelled by blood flow through the intracranial circulation and, in most cases, can be guided directly into the aneurysm, thus preserving the parent vessel. If an aneurysm neck is not present, test occlusion of the parent vessel is performed and, if tolerated, the balloon is detached. Twenty-six aneurysms in 25 patients have been treated by this technique. The aneurysms have involved the distal vertebral artery (five cases), the mid-basilar artery (six cases), the distal basilar artery (11 cases), and the posterior cerebral artery (four cases). The aneurysms varied in size and included three small (< 12 mm), 15 large (12 to 25 mm), and eight giant (> 25 mm). Fifteen patients (60%) presented with hemorrhage and 10 patients (40%) with mass effect. In 17 cases (65%) direct balloon embolization of the aneurysm was achieved with preservation of the parent artery. In nine cases (35%), because of aneurysm location and size, occlusion of the parent vessel was performed. Complications from therapy included three cases of transient cerebral ischemia which resolved, three cases of stroke, and five deaths due to immediate or delayed aneurysm rupture. The follow-up period has ranged from 2 months to 43 months (mean 22.5 months). In cases where posterior circulation aneurysms have been difficult to treat by conventional neurosurgical techniques, intravascular detachable balloon embolization may offer an alternative therapeutic option.

Cerebral cysticercosis with aqueductal obstruction

1980 ◽  
Vol 53 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Tung Pui Poon ◽  
Edward J. Arida ◽  
Wolodymyr P. Tyschenko
Keyword(s):  
Intracranial Hypertension ◽  
Brain Stem ◽  
Normal Pressure Hydrocephalus ◽  
Signs And Symptoms ◽  
Normal Pressure ◽  
Content Type ◽  
Neurological Signs ◽  
Cerebral Cysticercosis ◽  
The Brain ◽  
Fine Print

✓ The authors report a case of cerebral cysticercosis which presented with generalized nonspecific neurological signs and symptoms attributed to acute aqueductal obstruction, with concomitant intracranial hypertension. These were characteristic intracranial calcifications along with angiographically demonstrated signs of hydrocephalus. Contrast encephalography clearly demonstrated aqueductal obstruction. Pathologically, the aqueductal obstruction was shown to be due to parasitic invasion of the brain stem with compression of the aqueduct. The presence of typical intracranial calcification in conjunction with either obstructive or normal-pressure hydrocephalus should alert the observer to the possibility of cerebral cysticercosis.

Successful cerebral artery stent placement for total occlusion of the vertebrobasilar artery in a patient suffering from acute stroke

1999 ◽  
Vol 90 (5) ◽  
pp. 955-958 ◽  
Author(s):  
Takahisa Mori ◽  
Ken Kazita ◽  
Masato Seike ◽  
Yuji Nojima ◽  
Koreaki Mori
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Cerebral Artery ◽  
Stent Placement ◽  
Therapeutic Option ◽  
Coronary Stents ◽  
Total Occlusion ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Fine Print

✓ A 64-year-old man suffering from crescendo brainstem symptoms due to acute total occlusion of the vertebrobasilar artery was successfully treated by cerebral artery stent placement. The total occlusion of a long segment of the vertebrobasilar artery was completely recanalized by implanting two flexible, balloon-expandable coronary stents. The patient's clinical outcome 30 days later was favorable. No complications occurred during or after the procedure. This therapeutic option may prove to be a useful means to revascularize an acute total occlusion of the vertebrobasilar artery.

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