aneurysm. NBCA is injected and filled into the aneurysm. F: Postoperative CT scan demonstrates NBCA cast on the hematoma. One month after the endovascular therapy, the implantable LVAD was removed, and extracorporeal LVAD was temporarily inserted. After the bloodstream infection was controlled, he underwent implantation of Jarvik 2000 PA again. Finally, he received a heart transplant 11 months after LVAD replacement. He was free from neurological symptoms and was independent 2 years after the heart transplant. Discussion LVAD-supported patients are at high
Tomohiro Okuda, Ataru Nishimura, Koichi Arimura, Katsuma Iwaki, Takeo Fujino, Tomoki Ushijima, Hiromichi Sonoda, Yoshihisa Tanoue, Akira Shiose, and Koji Yoshimoto
Sabareesh K. Natarajan, Paresh Dandona, Yuval Karmon, Albert J. Yoo, Junaid S. Kalia, Qing Hao, Daniel P. Hsu, L. Nelson Hopkins, David J. Fiorella, Bernard R. Bendok, Thanh N. Nguyen, Marilyn M. Rymer, Ashish Nanda, David S. Liebeskind, Osama O. Zaidat, Raul G. Nogueira, Adnan H. Siddiqui, and Elad I. Levy
H yperglycemia at the time of ischemic stroke presentation has been shown to be associated with poor outcomes 5 , 23 , 30 and reduced salvage of ischemic penumbra from infarction, and it corresponds with a larger final infarct size (as measured by MR imaging). 2 , 8 , 20 , 22 Patients undergoing endovascular therapy for AIS represent a highly selected cohort due to the following factors: 1) they are treated up to 8 hours after the onset of stroke symptoms (as supported by the MERCI, 11 , 25 Multi MERCI, 24 and Penumbra 21 trials); 2) they have higher
Justin R. Mascitelli, Michael T. Lawton, Benjamin K. Hendricks, Trevor A. Hardigan, James S. Yoon, Kurt A. Yaeger, Christopher P. Kellner, Reade A. De Leacy, Johanna T. Fifi, Joshua B. Bederson, Felipe C. Albuquerque, Andrew F. Ducruet, Lee A. Birnbaum, Jean Louis R. Caron, Pavel Rodriguez, and J Mocco
R andomized controlled trials 1 , 2 have demonstrated the superiority of endovascular therapy (EVT) compared to microsurgery (MS) in the treatment of ruptured intracranial aneurysms, but these findings may not apply to all subsets of aneurysms. Wide neck aneurysms (WNAs) are of particular clinical interest because, compared to narrow neck aneurysms, they are more challenging to treat and require more advanced techniques. 3 From an EVT standpoint, adjunctive techniques such as balloon-assisted coiling (BAC), stent-assisted coiling (SAC), flow diversion
Shuichi Suzuki, Reza Jahan, Gary R. Duckwiler, John Frazee, Neil Martin, and Fernando Viñuela
facility or a delay before the patient could be medically stabilized prior to the procedure. The indications for endovascular therapy included anticipated surgical difficulty in six patients (5.4%), failed aneurysm clip placement in 15 patients (13.5%), and poor neurological grade or medical condition in 90 patients (81.1%). Technical Points of Endovascular Coil Embolization All endovascular coil embolization procedures were performed by two interventional neuroradiologists in a dedicated neurointerventional angiography suite. All patients were in a state of
Justin R. Mascitelli, J Mocco, Trevor Hardigan, Benjamin K. Hendricks, James S. Yoon, Kurt A. Yaeger, Christopher P. Kellner, Reade A. De Leacy, Johanna T. Fifi, Joshua B. Bederson, Felipe C. Albuquerque, Andrew F. Ducruet, Lee A. Birnbaum, Jean Louis R. Caron, Pavel Rodriguez, and Michael T. Lawton
W ide-neck aneurysms (WNAs) are a subset of intracranial aneurysms that are of clinical interest because they are more challenging to treat and require more advanced endovascular therapy (EVT) and microsurgery (MS) techniques than narrow-neck aneurysms. 1 , 2 From the EVT standpoint, adjunctive techniques such as use of balloon-assisted coiling (BAC), 3 stent-assisted coiling (SAC), 4 flow diversion (FD), 5 intrasaccular devices, 6 and novel neck-support devices 7 , 8 have been developed specifically for the treatment of WNAs. From the MS standpoint
Christina M. Sayama, James K. Liu, and William T. Couldwell
✓Cerebral vasospasm remains a major source of morbidity and death in patients with aneurysmal subarachnoid hemorrhage (SAH). When vasospasm becomes refractory to maximal medical management consisting of induced hypertension and hypervolemia and administration of calcium channel antagonists, endovascular therapies should be considered. The primary goal of endovascular treatment is to increase cerebral blood flow to prevent cerebral infarction. Two of the more frequently studied endovascular treatments are transluminal balloon angioplasty and intraarterial papaverine infusion. These two have been used either alone or in combination for the treatment of vasospasm. Other pharmacological vasodilating agents currently being investigated are intraarterial nimodipine, nicardipine, verapamil, and milrinone. Newer intraarterial agents, such as fasudil and colforsin daropate, have also been investigated. In this article the authors review the current options in terms of endovascular therapies for treatment of cerebral vasospasm. The mechanism of action, technique of administration, clinical effect and outcomes, and complications of each modality are discussed.
Yassine Kanaan, David Kaneshiro, Kenneth Fraser, David Wang, and Giuseppe Lanzino
The endovascular treatment of intracranial aneurysms has recently become an established therapeutic option. The foundation of this treatment modality was laid by the work done in ground-breaking cases, combined with technological advances since the first half of the 19th century. In this historical overview the authors describe the steps taken by the early pioneers and the results of their work, which was often done under challenging circumstances. The work of these predecessors established the stepping-stones for constant development and refinement for those who have come after them, eventually evolving into the procedures used today. Endovascular treatment of intracranial aneurysms is only possible because of the work of these innovators.
Siamak Asgari, Arnd Doerfler, Isabel Wanke, Beate Schoch, Michael Forsting, and Dietmar Stolke
T he primary aims in aneurysm therapy are to prevent rebleeding and to achieve complete occlusion of the aneurysm with preservation of the parent vessel. After endovascular therapy, the degree of occlusion is estimated from the final angiography study. After clipping, however, the routine use of postoperative angiography for cerebral aneurysms is a matter of ongoing debate. In a large microsurgical treatment series, postoperative angiography demonstrated residual aneurysms in 1.6 to 14% of cases. 3, 20, 27, 31 The incidence of rerupture for the postoperative
Thanh N. Nguyen, Jean Raymond, François Guilbert, Daniel Roy, Maxime D. Bérubé, Mostafa Mahmoud, and Alain Weill
P rocedure-related rupture, one of the most feared complications of endovascular therapy for ruptured aneurysms, is associated with high rates of neurological disability (5–63%) 2 , 7 and mortality (20–63%). 4 , 12 , 13 , 16 In a large meta-analysis, ruptured aneurysm was confirmed as a risk factor for procedure-related rupture. 2 Small size has also been reported as a risk factor, 14 , 18 but this was recently challenged. 15 Confirmation of size as a risk factor for procedure-related rupture is important for better estimates of patient risk
Rocco A. Armonda, Jeffrey E. Thomas, and Robert H. Rosenwasser
Endovascular surgical technology is in the early stages of evolution. A critical phase of this development has been microcatheter technology, which has permitted sufficiently precise intravascular navigation to safely engage the lumen of the aneurysm itself. Digital subtraction angiography, rapid filming techniques and image acquisition, and simultaneous multiplanar imaging capability are indispensable tools that are constantly being refined in the setting of ever-improving computer technology. The marriage of these different technologies has allowed effective endovascular treatment of difficult-to-access aneurysms in medically compromised patients for whom open microsurgery has inherently higher risks.