scholarly journals Cerebral Revascularization for the Management of Symptomatic Pure Arterial Malformations

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaocheng Lu ◽  
Xinggen Fang ◽  
Yabo Huang ◽  
Peng Zhou ◽  
Zhong Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebral Arteries ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Left Internal Carotid Artery ◽  
Anterior Circulation ◽  
Appropriate Treatment ◽  
The Right ◽  
Proximal Occlusion

Background: Pure arterial malformations (PAMs) are extremely rare abnormalities defined as dilated, overlapping, and tortuous arteries with a coil-like appearance in the absence of venous components. Over the last half century, only seven published reports have described cases of patients with PAMs who received treatment.Methods: Here, we report two cases of women with PAMs who received surgical treatment, and we present a systematic review of the literature. We searched the PubMed, Embase, Web of Science, and Medline databases (up until October 1, 2021) for relevant publications. We performed independent-sample t-tests and Fisher's exact tests to compare continuous and categorical characteristics among the available cases.Results: Our first patient was a 43-year-old woman with PAM of the left internal carotid artery (ICA), who received an ICA-radial artery (RA)-M2 bypass. Post-operative digital subtraction angiography (DSA) revealed the disappearance of the left ICA PAM without ischemic events during follow-up. The second patient was a 53-year-old woman with PAMs of the right ICA and posterior cerebral artery. The P1 lesion was treated by proximal occlusion combined with a superficial temporal artery-P2 bypass. During the 12-month follow-up period, the size of the PAMs decreased significantly as indicated by the post-operative DSA showing the absence of hemorrhages. Our systematic review, which includes 56 PAMs, shows that the reported PAMs were more common in the anterior circulation (33/56, 58.9%) than in the posterior circulation (11/56, 19.7%). Bilateral PAMs were more likely to affect bilateral anterior cerebral arteries (ACA) (ACAbilateral vs. ACAunilateral: 63.6 vs. 26.2%, p = 0.02). In addition, PAMs involving the anterior circulation were likely to affect multiple arteries (anteriormulti vs. posteriormulti: 30.3 vs. 0%, p = 0.038).Conclusion: We found very few reports on treated PAMs; further studies with large sample sizes and long follow-up periods are required to explore the appropriate treatment strategy for PAMs.

Cerebral Revascularization Using Radial Artery Grafts for the Treatment of Complex Intracranial Aneurysms: Techniques and Outcomes for 17 Patients

Neurosurgery ◽  
2001 ◽  
Vol 49 (3) ◽  
pp. 646-659 ◽  
Author(s):  
Laligam N. Sekhar ◽  
John M. Duff ◽  
Chandrasekar Kalavakonda ◽  
Michael Olding
Keyword(s):  
Radial Artery ◽  
Intracranial Aneurysms ◽  
Superficial Temporal Artery ◽  
Surgical Techniques ◽  
Temporal Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Scale Scores ◽  
Aneurysm Dissection ◽  
Proximal Occlusion

Abstract OBJECTIVE The goal of this report is to illustrate the use of radial artery grafts as bypass conduits in the management of complex intracranial aneurysms and to describe a new “pressure distension technique” to eliminate postoperative vasospasm, which was a common problem early in our experience. METHODS This study included a series of 17 patients who were surgically treated between 1994 and January 2001 for complex intracranial aneurysms. Five patients were surgically treated without the pressure distension technique; for 12 patients, the technique was used to reduce postoperative vasospasm. Fourteen of the patients had anterior circulation aneurysms, and three had posterior circulation aneurysms. Five of the patients had undergone previous attempts at direct clipping or excision and reconstruction of the aneurysm in question, and embolization had been performed for one patient with a carotid-cavernous fistula. Thirteen patients underwent permanent revascularization combined with proximal occlusion, trapping, or clipping, and four patients underwent temporary revascularization for cerebral protection during anticipated prolonged occlusion of the parent vessel during aneurysm dissection. Surgical techniques are described, with particular reference to vessel collection and bypass techniques. RESULTS The outcomes for this group of patients, considering the complexity of the aneurysms and their “inoperability,” with respect to direct clipping, were satisfactory. The aneurysms were completely obliterated for all patients, and the grafts were patent for all except one patient on postoperative angiograms. There were two deaths, one attributable to systemic sepsis and the other attributable to cardiac arrest during a transbronchial biopsy. The postoperative Glasgow Outcome Scale scores were either better or the same for all other patients, compared with their preoperative scores. Three of the five patients treated before the institution of the pressure distension technique experienced vasospasm of the graft, with two of those patients requiring angioplasty. For one of those patients, angioplasty led to rupture of the graft. Vasospasm was not observed for any of the 12 patients for whom the pressure distension technique was used. We observed no morbidity related to radial artery collection. CONCLUSION Revascularization techniques are occasionally necessary for the surgical treatment of complicated intracranial aneurysms. The merits of the use of the radial artery as a bypass conduit are discussed. Radial artery grafts should be considered as alternatives to saphenous vein and superficial temporal artery grafts. The problem of vasospasm of the artery has been solved with the pressure distention technique.

scholarly journals Superficial temporal artery access for percutaneous coronary artery stenting during the COVID-19 pandemic: a case report

2020 ◽  
Author(s):  
Ádám Csavajda ◽  
Olivier F Bertrand ◽  
Béla Merkely ◽  
Zoltán Ruzsa
Keyword(s):  
Coronary Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Coronary Intervention ◽  
Femoral Access ◽  
St Segment Elevation ◽  
Invasive Cardiology ◽  
Percutaneous Coronary ◽  
Diagnostic Angiography ◽  
The Right

Abstract Background The COVID-19 pandemic creates new challenges for healthcare, including invasive cardiology. Case summary We discuss the case of a 65-year-old man who presented with non-ST segment elevation myocardial infarction combined with bilateral pneumonia. The patient had known severe iliac artery lesions with prior interventions and bilateral subclavian artery occlusions. After unsuccessful femoral artery access, the diagnostic angiography and the right coronary artery percutaneous coronary intervention were successfully performed from ultrasound-guided lower superficial temporal artery access. Discussion We showed that superficial temporal access can be used as an alternate access site for diagnostic coronary angiography and intervention when standard wrist and femoral access sites are not readily accessible.

scholarly journals Combining Internal Carotid Artery Occlusion with Intermediate-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: Case Report and Review of Literature

2019 ◽  
Vol 16 (1) ◽  
pp. 42-47
Author(s):  
Robin Bhattarai ◽  
Chuan Chen ◽  
Chao Feng Liang ◽  
Teng Chao Huang ◽  
Hui Wang ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Treatment Effectiveness ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Balloon Occlusion ◽  
The Right

We summarize the treatment effectiveness and experience of a patient who underwent internal carotid balloon occlusion combined with Intermediate-flow bypass as a treatment for large-giant cavernous sinus segment internalcarotid artery (CS ICA) aneurysms. A 62-year-old woman presented with a large aneurysm on the right side of the cavernoussinus with dizziness for about two years and Oculomot or nerve palsy. An extra cranial intracranial (EC-IC) Intermediate-flow by pass using a radial artery bypass graft (RABG) and proximal balloon occlusion of the Right ICA were performed. The patient experienced no new neurologic deficit after this treatment. Follow up radiologic evaluations using Computed Tomography Angiography revealed complete aneurysm occlusion. For patients with large-giant CS ICA aneurysms, treatment of ICA occlusion combined with Intermediate-flow superficial temporal artery-Radial artery-middle cerebralartery bypass surgery was an effective and safe surgical strategy.

TachoSil Dural Reconstruction in Extracranial-Intracranial Bypass Surgeries

2018 ◽  
Vol 80 (01) ◽  
pp. 039-043
Author(s):  
Behnam Jahromi ◽  
Christopher Ludtka ◽  
Stefan Schwan ◽  
Nakao Ota ◽  
Hans Meisel ◽  
...  
Keyword(s):  
Wound Healing ◽  
Dura Mater ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Clotting Factors ◽  
Bypass Patency ◽  
Technical Report ◽  
Csf Leakage ◽  
Cerebrovascular Stroke

Background Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a treatment option for hemodynamic insufficiency in the anterior cerebral circulation. Complications associated with extracranial-intracranial bypass surgeries are ischemic strokes caused by bypass failure, wound-healing disorders, and further issues from cerebrospinal fluid (CSF) leakage. CSF leakage can provide pathways for infection. It is well known in general neurosurgery that watertight closure of the dura mater is necessary to prevent such complications. Objective To provide a technical description of TachoSil dural reconstruction in standard STA-MCA bypasses and their follow-up analyses. Methods In this technical report with observational follow-up, the dura mater was closed partially by adaptive sutures, and the perforation site of the donor vessel was sealed with TachoSil. TachoSil is a collagen sponge covered with clotting factors that provides hemostatic and sealing effects. Results Our study included eight cases of standard STA-MCA bypasses that had been operated between July 2015 and September 2016. Follow-up examinations were completed for all patients at 1 month and 6 months after surgery. Duplex and Doppler ultrasound demonstrated regular bypass patency in all patients without increased flow velocity at the perforation sites, which is a possible sign of stenosis. No wound-healing disorders or CSF leakage occurred. No cerebrovascular stroke events were observed. Conclusion Duraplasty with TachoSil enables the elastic reconstruction of the dura perforation gap in standard extracranial-intracranial bypass surgeries.

scholarly journals Coats’ Retinitis or Retinoblastoma in a 3-Year-Old Girl: A Case Report

Medicina ◽  
2012 ◽  
Vol 48 (4) ◽  
pp. 32
Author(s):  
Alvydas Paunksnis ◽  
Daiva Imbrasienė ◽  
Rasa Liutkevičienė ◽  
Kristina Rilienė ◽  
Evaldas Keleras ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Abnormal Development ◽  
Eye Drops ◽  
Exudative Retinal Detachment ◽  
Hard Exudates ◽  
Appropriate Treatment ◽  
Department Of Ophthalmology ◽  
Coats Disease ◽  
The Right

Coats’ disease is an idiopathic disorder defined by an abnormal development of retinal vessels with a progressive deposition of intraretinal or subretinal exudates, leading to exudative retinal detachment. The most difficult task is to differentiate Coats’ disease from retinoblastoma. We present a rare case of Coats’ disease diagnosed in a 3-year-old girl. From the age of 6 months, the girl was followed up 2 times a year at the Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, due to congenital convergent strabismus and refractive errors. At the age of 3.6 years, a routine examination of the fundus of the right eye revealed hard exudates, telangiectasia and tortuosity, gray color lesion below the optic nerve disc, submacular exudation in the inferior nasal part of the retina, and exudative retinal detachment, which extended from the 7-o’clock position to the 4-o’clock position. Before this examination, no abnormalities were found in the fundus of her both eyes. The girl was not treated with laser photocoagulation, cryocoagulation, or intravitreal injections, as the diagnosis of retinoblastoma could not be excluded; therefore, only eye drops were prescribed. In order to exclude the diagnosis of retinoblastoma, ultrasonography, magnetic resonance imaging, and computed tomography were carried out, and an appointment to see an ophthalmic oncologist was scheduled. Due to early and appropriate treatment, the progression of Coats’ disease in patients could be arrested. However, in some cases, when the diagnosis is ambiguous, it is better to follow up the patient and to treat only with eye drops.

Superficial Temporal Artery: Distal Posterior Cerebral Artery Bypass through the Subtemporal Approach: Technical Note and Pilot Surgical Cases

2017 ◽  
Vol 13 (3) ◽  
pp. 309-316 ◽  
Author(s):  
Akitsugu Kawashima ◽  
Hugo Andrade-Barazarte ◽  
Behnam Rezai Jahromi ◽  
Minna Oinas ◽  
Ahmed Elsharkawy ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Subtemporal Approach ◽  
Ischemic Complications ◽  
Proximal Occlusion

Abstract BACKGROUND: Posterior cerebral artery (PCA) aneurysms are rare and the majority are fusiform in shape. Proximal occlusion of PCA represents a treatment option for these lesions. However, this procedure carries a high risk of ischemic complications. OBJECTIVE: To describe the technique of trapping a fusiform PCA aneurysm and revascularization of the distal PCA using a superficial temporal artery (STA) graft through the same microsurgical approach. METHODS: From September 2012 to October 2014, we retrospectively identified 3 patients harboring a fusiform PCA aneurysm (P2 segment aneurysm) who underwent trapping of the aneurysm and reconstruction of the distal PCA through the same subtemporal approach. We analyzed immediate morbidity, surgical complications, and the patency of the bypass to determine the feasibility of this procedure. RESULTS: All 3 patients underwent successful trapping of the fusiform PCA aneurysm and revascularization of the distal PCA. The origin of P3 segment or posterior temporal artery (PTA) served as recipient arteries. In all 3 cases, adequate blood flow was evident after performing the STA-P3/PTA bypass. None of the patients experienced a new permanent neurological deficit. At 1-year follow-up, the STA-PTA/PCA bypasses remained patent. CONCLUSION: The STA-P3/PTA bypass through the subtemporal approach is a feasible option to maintain blood flow in cases of PCA fusiform aneurysms requiring trapping of the P2 segment.

scholarly journals Intraarterial Thrombolysis with r-tPA for Treatment of Anterior Circulation Acute Ischemic Stroke

2003 ◽  
Vol 9 (3) ◽  
pp. 273-282
Author(s):  
F. Baltacioğlu ◽  
N. Afşar ◽  
G. Ekinci ◽  
N. Tuncer-Elmaci ◽  
N Çagatay Çimşit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Neurological Status ◽  
Treatment Modalities ◽  
Anterior Circulation ◽  
Main Trunk ◽  
History Of ◽  
The Right

To investigate factors effecting the safety and recanalization efficacy of local intraarterial (IA) recombinant tissue plasminogen activator (r-tPA) delivery in patients with acute ischemic stroke. Eleven patients with anterior circulation acute ischemic stroke were treated. The neurological status of the patients were graded with the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS). All patients underwent a computed tomography (CT) examination at admission. In addition four patients had diffusion-weighted and one patient had a perfusion magnetic resonance (MR) examinations. Patients were treated within six hours from stroke onset. Immediate, six hours, and 24 hours follow-up CT examinations were performed in order to evaluate the haemorrhagic complications and the extent of the ischemic area. The Rankin Scale (RS) was used as an outcome measure. Two of the 11 patients had carotid “T” occlusion (CTO), nine had middle cerebral artery (MCA) main trunk occlusion. Four patients had symptomatic haemorrhage with a large haematoma rupturing into the ventricles and subarachnoid space. Of these, three patients died within 24 hours. The remaining seven patients had asymptomatic haematomas that were smaller compared to symptomatic ones, and showed regression in size and density on follow-up CTs. At third month five patients had a good outcome and three patients had a poor outcome. In acute ischemic stroke, local IA thrombolysis is a feasible treatment when you select the right patient. Haemorrhage rate does not seem to exceed that occuring in the natural history of the disease and in other treatment modalities.

Treatment of fusiform aneurysms of the peripheral cerebral arteries

1978 ◽  
Vol 49 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Vinko Dolenc
Keyword(s):  
Cerebral Arteries ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Arterial Graft ◽  
Left Middle Cerebral Artery ◽  
Fusiform Aneurysm ◽  
Carotid Angiography ◽  
Content Type ◽  
First Case ◽  
Left Middle

✓ Two patients with fusiform aneurysms and at least one previous subarachnoid hemorrhage were treated by excision of the aneurysms and reconstruction of the arteries. The first case presented with two fusiform aneurysms, the larger of which involved the angular and the smaller one the temporal branch of the left middle cerebral artery (MCA). Both aneurysms were totally excised. The angular artery was reconstructed with a 1.5 cm long arterial graft taken from the left superficial temporal artery. Excision of the temporal aneurysm was followed by an end-to-end suture of the central and distal parts of the vessel. The second case had a fusiform aneurysm involving the temporal branch of the left MCA. The aneurysm was excised and an arterial graft 1 cm long cut from the superficial temporal artery was used in reconstruction of the affected vessel. In each case left carotid angiography was done 1 week postoperatively. In the first case the angiogram showed that the angular artery reconstructed with a graft was patent, whereas the temporal artery reconstructed without a graft was not visualized. In the second patient, whose temporal artery was reconstructed with a graft, angiography did not show the reconstructed artery. Left carotid angiography was repeated 1 year after the operation in both cases, and all the reconstructed vessels were well visualized.

scholarly journals Case Series on Perforator Aneurysm: Endovascular Stenting—A Safe Strategy

2017 ◽  
Vol 01 (03) ◽  
pp. 179-183 ◽  
Author(s):  
Chandra Sahu ◽  
Ashish Ashpilaya
Keyword(s):  
Case Series ◽  
Treated Group ◽  
Vascular Lesions ◽  
World Federation ◽  
Imaging Data ◽  
Anterior Circulation ◽  
Fisher Grade ◽  
Complete Thrombosis ◽  
The Right

AbstractPerforator aneurysms are rare vascular lesions that are infrequently reported in literature, and because of difficult anatomic approach, their treatment and management pose challenges. Given the rarity of these aneurysms, the natural history and ideal approach to treatment has not been established. The authors retrospectively analyzed six patients, age ranging from 16 to 75 years with ruptured perforator aneurysm, four of posterior circulation and two of anterior circulation including clinical characteristics, imaging data, treatment regimen, and outcome. All but two patients presented with the World Federation of Neurosurgical Societies grades I to III and Fisher grade 2 or 3 subarachnoid hemorrhage, and the other two presented with intracerebral bleed in the right gangliocapsular region. Four patients were managed conservatively whereas two basilar perforator aneurysms were treated with endovascular stent. At the last follow-up, the endovascularly treated group of patients demonstrated complete thrombosis of aneurysm with preservation of perforators, and the conservatively managed group showed spontaneous occlusion in one patient, whereas three were lost to follow-up and ultimate outcome remains unknown. The authors report single-center hospital-based experience in six patients, which adds to the scarce published literature that addresses the limited understanding of the natural course and consolidating safe endovascular management of this entity.

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