- Temporary Stent-Assisted Coil Embolization as a Treatment Option for Wide-Neck Aneurysms
The authors intended to treat 33 aneurysms between January 2010 and December 2015 with temporary stent-assisted coiling, which formed the series for this study. Incidental and acutely ruptured aneurysms were included. Sufficient occlusion was achieved in 97.1% of the cases. In 94%, the stent could be fully recovered. Complications occurred in 5 patients (14.7%). They conclude that temporary stent-assisted coiling is an effective technique for the treatment of wide-neck aneurysms. Safety is comparable with that of stent-assisted coiling and coiling with balloon remodeling.
- Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents
The authors report their experience treating basilar apex aneurysms with flow-diverter stents and evaluate their efficacy and safety profile in this specific condition. Of the 175 aneurysms treated with flow-diverter stents at their institution, 5 patients received flow-diverter stents for basilar apex aneurysms. The mean follow-up after stent deployment was 21 months. They conclude that flow diversion is a feasible technique with an efficacy demonstrated at a midterm follow-up, especially in the case of basilar apex aneurysm recurrences after previous endovascular treatments.
- Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography
Ninety-four flat panel catheter angiotomography acquisitions obtained during the selective injection of intersegmental arteries providing an anterior radiculomedullary artery were reviewed. The location of radicular arteries could be ascertained in 78/94 flat panel catheter angiotomography acquisitions. Fifty-three acquisitions (67.9%) were on the left side, and 25 (32.1%), on the right, between T2 and L3. The arteries were found in the anterosuperior quadrant in 75 cases (96.2%), in the posterosuperior quadrant in 2 (2.6%), and in the anteroinferior quadrant in 1(1.3%). Needle placement in the anterosuperior quadrant (subpedicular approach) should be avoided during transforaminal epidural steroid injection. The authors advocate the posterolateral approach that allows placing the needle tip away from the documented position of ARMA contributors within the neural foramen, reducing the risk of intra-arterial injection or injury to the spinal vascularization.
- Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
The authors evaluated the potential relationship between thrombus histology and clot stability in 85 patients with anterior circulation stroke treated with thrombectomy. The number and location of emboli after retrieving the primary thrombus, the number of maneuvers, and TICI scores were evaluated. H&E and neutrophil elastase staining of retrieved clots was performed. An inverse correlation between maneuvers required for thrombus retrieval and the number of distal and intermediate emboli was observed. Younger patients were at higher risk for periprocedural thrombus fragmentation. Bridging thrombolysis tended to be associated with fewer maneuvers but more emboli. They conclude that younger age, easy-to-retrieve thrombi, and bridging thrombolysis may be risk factors for periprocedural thrombus fragmentation. Higher neutrophil levels in the thrombus tissue were related to an increased risk of periprocedural thrombus fragmentation.
- Evaluation of Collaterals and Clot Burden Using Time-Resolved C-Arm Conebeam CT Angiography in the Angiography Suite: A Feasibility Study
Ten C-arm conebeam CT perfusion datasets from 10 subjects with acute ischemic stroke acquired before endovascular treatment were retrospectively processed to generate time-resolved conebeam CTA. From time-resolved conebeam CTA, 2 experienced readers evaluated the clot burden and collateral flow in consensus by using previously reported scoring systems and assessed the clinical value of this novel imaging technique. The 2 readers agreed that time-revolved C-arm conebeam CTA was the preferred method for evaluating the clot burden and collateral flow compared with other conventional imaging methods. They conclude that comprehensive evaluations of clot burden and collateral flow are feasible by using time-resolved C-arm conebeam CTA data acquired in the angiography suite.
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