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Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms

Clinical article

Ross C. Puffer, David F. Kallmes, Harry J. Cloft, and Giuseppe Lanzino

Object

In this study the authors determined the patency rate of the ophthalmic artery (OphA) after placement of 1 or more flow diversion devices across the arterial inlet for treatment of proximal internal carotid artery (ICA) aneurysms, and correlated possible risk factors for OphA occlusion.

Methods

Nineteen consecutive patients were identified (mean age 53.9 years, range 23–74 years, all female) who were treated for 20 ICA aneurysms. In all patients a Pipeline Embolization Device (PED) was placed across the ostium of the OphA while treating the target aneurysm. Flow through the OphA after PED placement was determined by immediate angiography as well as follow-up angiograms (mean 8.7 months), compared with the baseline study. Potential risk factors for OphA occlusion, including age, immediate angiographic flow through the ophthalmic branch, status of flow within the aneurysm after placement of PEDs, whether the ophthalmic branch originated from the aneurysm dome, and number of PEDs placed across the ophthalmic branch inlet were correlated with patency rate.

Results

Patients were treated with 1–3 PEDs (3 aneurysms treated with placement of 1 PED, 12 with 2 PEDs, and 5 with 3 PEDs). In 17 (85%) of 20 treated aneurysms, no changes in the OphA flow were noted immediately after placement of the device. Two (10%) of 20 patients had delayed antegrade filling immediately following PED placement and 1 patient (5%) had retrograde flow from collaterals to the OphA immediately after placement of the device. One patient (5%) experienced delayed asymptomatic ICA occlusion; this patient was excluded from analysis at follow-up. At follow-up the OphA remained patent with normal antegrade flow in 13 (68%) of 19 patients, patent but with slow antegrade flow in 2 patients (11%), and was occluded in 4 patients (21%). No visual changes or clinical symptoms developed in patients with OphA flow compromise. The mean number of PEDs in the patients with occluded OphAs or change in flow at angiographic follow-up was 2.4 (SEM 0.2) compared with 1.9 (SEM 0.18) in the patients with no change in OphA flow (p = 0.09). There was no significant difference between the patients with occluded OphAs compared with nonoccluded branches based on patient age, immediate angiographic flow through the ophthalmic branch, status of flow through the aneurysm after placement of PEDs, whether the ophthalmic branch originated from the aneurysm dome, or number of PEDs placed across the ophthalmic branch inlet.

Conclusions

Approximately one-quarter of OphAs will undergo proximal thrombosis when covered with flow diversion devices. Even though these events were well-tolerated clinically, our findings suggest that coverage of branch arteries that have adequate collateral circulation may lead to spontaneous occlusion of those branches.

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Postangiographic thrombosis of a spinal arteriovenous malformation

Case report

Vipul Gupta, Tanvir Rizvi, Ajay Garg, Shailesh B. Gaikwad, and N. K. Mishra

sufficient to confirm thrombosis. In our case, 3-month follow-up MR imaging revealed no evidence of recanalization. Follow-up angiography has been recommended at 1 year. Conclusions Postangiographic thrombosis of spinal AVMs is rare and has not been reported previously. Draining vein stenosis precipitated by contrast injection during diagnostic angiography was the most probable cause of AVM occlusion. Abbreviations used in this paper AVM = arteriovenous malformation ; DS = digital subtraction ; MR = magnetic resonance

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Combined surgical and endovascular treatment of a spontaneous diploic arteriovenous fistula

Case report

Ingrid M. Burger, Rafael J. Tamargo, Jennifer Broussard, and Philippe Gailloud

cyst formation. Abbreviations used in this paper AVF = arteriovenous fistula ; DS = digital subtraction ; MMA = middle meningeal artery ; STA = superficial temporal artery . References 1. El Deeb M , Sedano HO , Waite DE : Aneurysmal bone cyst of the jaws. Report of a case associated with fibrous dysplasia and review of the literature. Int J Oral Surg 9 : 301 – 311 , 1980 El Deeb M, Sedano HO, Waite DE: Aneurysmal bone cyst of the jaws. Report of a case associated

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Intraoperative power Doppler ultrasonography with a contrast-enhancing agent for intracranial tumors

Hiroshi Kanno, Yukihiko Ozawa, Katsumi Sakata, Hidemitsu Sato, Yutaka Tanabe, Nobuyuki Shimizu, and Isao Yamamoto

abundant vessels such as hemangioblastomas. Abbreviations used in this paper AA = anaplastic astrocytoma ; CT = computerized tomography ; DS = digital subtraction ; GBM = glioblastoma multiforme ; MR = magnetic resonance . References 1. Barnett GH : The role of image-guided technology in the surgical planning and resection of gliomas . J Neurooncol 42 : 247 – 258 , 1999 Barnett GH: The role of image-guided technology in the surgical planning and resection of gliomas

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Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms

Pedro Lylyk, Angel Ferrario, Boris Pabón, Carlos Miranda, and Gustavo Doroszuk

treatment of complex wide-necked aneurysms in which endovascular reconstruction of the parent vessel is necessary. Early in our experience, we found that stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although our early results are promising, the long-term benefit of this technique has to be proved by follow-up angiographic and clinical examinations. Abbreviations used in this paper DS = digital subtraction ; ICA = internal carotid artery ; SAH = subarachnoid hemorrhage

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Combined transvenous and transarterial embolization of a tentorial—incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus

Case report

Neil A. Troffkin, Cole Blease Graham III, Turgut Berkmen, and Ajay K. Wakhloo

Endovascular approaches offer the possibility of definitive treatment by using combined venous and arterial embolizations. Treatment of the frequently associated stenotic dural sinus is a natural extension of the endovascular approach to these lesions. If a stenotic sinus is found, consideration should be given to primary stent placement to reduce venous hypertension and the chance of ICH. Abbreviations used in this paper AVM = arteriovenous malformation ; DS = digital subtraction ; ECA = external carotid artery ; GDC

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Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes

Jaechan Park, Hyunjin Woo, Dong-Hun Kang, Yong-Sun Kim, Min Young Kim, Im Hee Shin, and Sang Gyu Kwak

.2) 16.4 (38.0) DS = digital subtraction. * Period A = period with formal emergency treatment between 2008 and 2011; Period B = period with broadly defined early treatment (< 3 days of SAH) between 2001 and 2004. † Values in bold are statistically significant. ‡ Chi-square test. § Two-sample t-test. While there was no significant difference in the age, sex, WFNS clinical grade, site of the ruptured aneurysm, or time interval from SAH to admission between the patients from Period A and the patients from Period B, there was a difference in the

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Three-dimensional blood flow analysis in a wide-necked internal carotid artery—ophthalmic artery aneurysm

Satoshi Tateshima, Fernando Viñuela, J. Pablo Villablanca, Yuichi Murayama, Taku Morino, Kiyoe Nomura, and Kazuo Tanishita

the cerebral aneurysm, and Dr. Yih Lin Nien Shy for his great assistance in the preparation of this manuscript. Abbreviations used in this paper ACA = anterior cerebral artery ; CT = computerized tomography ; DS = digital subtraction ; ICA = internal carotid artery ; LDV = laser Doppler velocimetry ; MCA = middle cerebral artery ; OphA = ophthalmic artery ; PIV = particle image velocimetry ; 3D = three-dimensional . References 1. Burleson AC