Embolization of Brain Aneurysms and Arteriovenous
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Endovascular Procedures for Intracranial Arterial Disease
Corporate Medical Policy Endovascular Procedures for Intracranial Arterial Disease File Name: endovascular_procedures_for_intracranial_arterial_disease Origination: 2/1996 Last CAP Review: 5/2021 Next CAP Review: 5/2022 Last Review: 5/2021 Description of Procedure or Service Intracranial arterial disease includes thromboembolic events, vascular stenoses, and aneurysms. Endovascular techniques have been investigated for treatment of intracranial arterial disease. Endovascular therapy is used as an alternative or adjunct to intravenous tissue plasminogen activator (tPA) and supportive care for acute stenosis and as an adjunct to risk factor modification for chronic stenosis. For cerebral aneurysms, stent-assisted coiling and the use of flow-diverting stents have been evaluated as an alternative to endovascular coiling in patients whose anatomy is not amenable to simple coiling. Background Cerebrovascular diseases include a range of processes affecting the cerebral vascular system, including arterial thromboembolism, arterial stenosis, and arterial aneurysms, all of which can lead to restrictions in cerebral blood flow due to ischemia or hemorrhage. Endovascular techniques, including endovascular mechanical embolectomy with various types of devices (i.e., stents), and angioplasty with or without stenting, have been investigated for treatment of cerebrovascular diseases. Acute Stroke Acute stroke is the fifth leading cause of death in the United States; further, it is a leading cause of adult disability. Eighty-seven percent of strokes are ischemic and 13% hemorrhagic. Differentiation between the two types of stroke is necessary to determine the appropriate treatment. Ischemic stroke occurs when an artery to the brain is blocked by a blood clot, which forms in the artery (thrombotic), or when another substance (i.e., plaque, fatty material) or a blood clot travels to an artery in the brain causing a blockage (embolism). -
Novel Device for Treating Wide Neck Bifurcation Brain Aneurysms – First Pulse Rider Case at UCLA
24/7 Contact & Appointment INTERVENTIONAL NEURORADIOLOGY (310) 267-8761 or 8762 Novel device for treating wide neck bifurcation brain aneurysms – First Pulse Rider case at UCLA PATIENT PRESENTATION DIVISION OF INTERVENTIONAL NEURORADIOLOGY Presents a patient case treated by • 62 year old woman was found to the team members of the division have an asymptomatic basilar and physicians and staff of the UCLA Comprehensive Stroke Center artery aneurysm. • She was referred to UCLA for higher level of care. GARY DUCKWILER, MD Director and Professor • Her MRA imaging from the outside FERNANDO VINUELA, MD facility revealed wide neck 7mm Professor Emeritus basilar artery tip aneurysm (Fig.1). Figure 1: Brain MRA demonstrating a basilar artery tip 7mm aneurysm (yellow arrow). REZA JAHAN, MD Professor SATOSHI TATESHIMA, MD, DMSc Associate Professor EVALUATION AND IMAGING VIKTOR SZEDER, MD, PhD, MSc Assistant Professor • We performed a cerebral angiogram to better characterize GEOFFREY COLBY, MD, PhD Associate Professor the anatomy of the aneurysm as well as the basilar artery and its MAY NOUR, MD, PhD Assistant Professor branches. • Angiogram (Fig. 2) revealed wide neck irregularly shaped basilar artery tip aneurysm. The two posterior cerebral arteries Figure 2: Digital subtraction angiography (DSA) branching of the basilar artery were demonstrating a 6.9 mm irregularly shaped wide found to be in favorable angles for neck basilar tip aneurysm (yellow arrow). Pulse Rider device assisted coiling treatment. 24/7 Contact & Appointment INTERVENTIONAL NEURORADIOLOGY (310) 267-8761 or 8762 INTERVENTION PERFORMED Fig 3. Fig 4. Fig 5. • Pulse Rider assisted coiling was performed. Pulse Rider device was placed into the distal basilar artery with its 2 wings in posterior cerebral arteries. -
Balloon Assisted Technique in Peripheral Interventions: a Use- Ful Tool
Pozzi Mucelli F, et al., J Angiol Vasc Surg 2019, 4: 022 DOI: 10.24966/AVS-7397/100022 HSOA Journal of Angiology & Vascular Surgery Case Report technique is rarely reported [2-5]. We describe some original applica- Balloon Assisted Technique in tions of BAT of our experience. Peripheral Interventions: A Cases Description Giant aneurysm of pancreatic-duodenal artery. Female, 65 yrs Useful Tool Abdominal CT exam identified a 5 cm aneurysm of pancreatic-du- Pozzi Mucelli Fabio, Pozzi Mucelli Roberta Antea* , Sacconi odenal artery probably due to occlusion of the origin of the celiac Francesca, Braini Massimiliano, Belgrano Manuel Gianvalerio trunk caused by Dunbar Syndrome. Follow-up CT demonstrated a and Cova Maria Assunta mild enlargement of the aneurysm and for this reason an endovascular Department of Radiology, Azienda Sanitaria Universitaria Integrata di treatment was proposed. Coiling of the aneurysm was rejected due to Trieste, Trieste, Italy the risk of occlusion of the parent artery feeding the gastroduodenal, hepatic and splenic artery and we considered to exclude the aneurysm with a flow-diverter stent. Procedure was done in local anesthesia Abstract using brachial approach. After Superior Mesenteric Artery (SMA) catheterization a 6F guiding catheter (Envoy Cardinal Health) was Balloon Assisted Technique (BAT) consists in the use of a balloon advanced at the origin of the pancreatic-duodenal artery, close to the catheter advanced in a parallel fashion to main catheter in the same aneurysm (Figure 1a). A .014 guidewire (V14 Boston) was advanced artery to overcome problems during endovascular interventions. We describe three different cases of BAT. The first case is an example distally to the aneurysm, but with a large “loop” inside it (Figure 1b). -
Spontaneous Hemothorax Caused by a Ruptured Intercostal Artery Aneurysm in Von Recklinghausen’S Neurofibromatosis
W.C. Chang, H.H. Hsu, H. Chang, et al BRIEF COMMUNICATION SPONTANEOUS HEMOTHORAX CAUSED BY A RUPTURED INTERCOSTAL ARTERY ANEURYSM IN VON RECKLINGHAUSEN’S NEUROFIBROMATOSIS Wei-Chou Chang,1 Hsian-He Hsu,1 Hung Chang,2 and Cheng-Yu Chen1 Abstract: Aneurysms arising from an intercostal artery are very rare vascular malformations in von Recklinghausen’s neurofibromatosis, which often have a silent clinical presentation and are difficult to diagnose before rupture. We report a case of von Recklinghausen’s neurofibromatosis with massive hemothroax caused by spontaneous rupture of an intercostal artery aneurysm in a 29-year-old man. The diagnosis was eventually confirmed by percutaneous angiography and treated with endovascular embolization. During a 10-month follow-up period, the patient had a satisfactory recovery. This case illustrates that angiography and possible endovascular embolization should be the first strategy in managing hemothorax in patients with von Recklinghausen’s disease. Key words: Aneurysm, ruptured; Embolization, therapeutic; Hemothorax; Neurofibromatosis 1; Thoracic arteries J Formos Med Assoc 2005;104:286-9 Von Recklinghausen’s neurofibromatosis, also named neurofibromatosis type 1 (NF-1), is a well-recognized Case Report entity that is characterized by numerous neuro- fibromas, spots of abnormal cutaneous pigmentation, A 29-year-old man presented at the emergency room and a variety of other dysplastic abnormalities of with sudden onset shortness of breath and severe the skin, nervous system, bones, endocrine organs and retrosternal pain radiating to his back. One week prior blood vessels.1,2 Vascular abnormalities in patients to admission, dull discomfort upon breathing was with NF-1 have been described for large, medium- noted, which was not affected by position or physical sized and small muscular arteries in the intracranial, activity. -
Complications Associated with the Use of Flow-Diverting Devices for Cerebral Aneurysms: a Systematic Review and Meta-Analysis
NEUROSURGICAL FOCUS Neurosurg Focus 42 (6):E17, 2017 Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis Geng Zhou, PhD,1 Ming Su, MD,2 Yan-Ling Yin, MD,3 and Ming-Hua Li, PhD1 1Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai; 2Shandong Academy of Chinese Medicine, Lixia, Jinan; and 3Department of Anesthesiology, The Military General Hospital of Beijing PLA, Beijing, China OBJECTIVE The objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by perform- ing a meta-analysis of published studies. METHODS A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta- analysis was used to pool the complication rates across studies. RESULTS Sixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%–20.5%) and a low mortal- ity rate of 2.8% (95% CI 1.2%–4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%–5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline emboliza- tion device and the Silk flow-diverter device). -
(Tubridge) for the Treatment of 28 Large Or Giant Intracranial Aneurysms: a Single-Center Experience
ORIGINAL RESEARCH INTERVENTIONAL A Novel Flow-Diverting Device (Tubridge) for the Treatment of 28 Large or Giant Intracranial Aneurysms: A Single-Center Experience Y. Zhou, P.-F. Yang, Y.-B. Fang, Y. Xu, B. Hong, W.-Y. Zhao, Q. Li, R. Zhao, Q.-H. Huang, and J.-M. Liu ABSTRACT BACKGROUND AND PURPOSE: The Tubridge flow diverter is a novel device developed in China and aimed at reconstructing the parent artery and occluding the aneurysm. We conducted this study to evaluate its feasibility, safety, and efficacy for the treatment of large or giant internal carotid artery aneurysms, which are still challenging with conventional therapy. MATERIALS AND METHODS: The clinical and angiographic data of 28 patients with 28 large or giant internal carotid artery aneurysms treated with Tubridge flow diverters were prospectively collected and analyzed. RESULTS: Thirty-three Tubridge flow diverters were successfully implanted except for 1 poor midstent opening; the result was a technical success rate of 97.0% (32/33). Follow-up angiographies were available for 25 aneurysms; the mean follow-up was 9.9 months (5–24 months). Of the 25 aneurysms, 18 (72.0%) were completely occluded, 6 (24.0%) were improved, and 1 (4.0%) was unchanged. All of the visible covered branches and parent arteries were patent, with no stenosis or obliteration. During a follow-up of 6–30 months (mean, 19 months), symptoms were resolved in 13 patients, improved in 6 patients, and unchanged in 4 patients. Five patients experienced transient clinical deterioration due to a postoperative increased mass effect. Procedure-related morbidity and mortality were both zero. -
Pipeline Flow Diversion of Ruptured Blister Aneurysms of the Supraclinoid Carotid Artery Using a Single-Device Strategy
NEUROSURGICAL FOCUS Neurosurg Focus 42 (6):E11, 2017 Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy Robert W. Ryan, MD, Amir S. Khan, MD, Rebecca Barco, BSN, SCRN, and Armen Choulakian, MD Department of Neurosurgery, UCSF Fresno, California OBJECTIVE Ruptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall. Historical challenges with both open microsurgical approaches and intrasaccular endovascular approaches have led to increased use of flow diversion for management of these aneurysms. However, the optimum paradigm, including timing of treatment, use of dual antiplatelet therapy, and number of flow-diverter devices to use remains unknown. The authors describe their experience with ruptured blister aneurysms treated with flow diversion at their institution, and discuss rates of rebleeding and number of devices used. METHODS All patients presenting with subarachnoid hemorrhage from a ruptured blister aneurysm and treated with Pipeline flow diversion were identified. Patient demographic data, clinical status and course, need for external ventricular drain (EVD), timing of treatment, and angiographic details and follow-up were recorded. RESULTS There were 13 patients identified (11 women and 2 men), and 4 had multiple aneurysms. Two aneurysms were treated on initial angiography, with average time to treatment of 3.1 days for the remainder, after discussion with the family and institution of dual antiplatelet therapy. Device placement was technically successful in all patients, with 2 patients receiving 2 devices and the remainder receiving 1 device. There was 1 intraoperative complication, of a wire perforation causing intracerebral hemorrhage requiring decompressive craniectomy. -
Uterine Fibroid Embolization Procedure, How It Is Used, and What Results to Expect
UW MEDICINE | PATIENT EDUCATION | | Angiography: Uterine Fibroid | Embolization | How to prepare and what to expect This handout explains a uterine fibroid embolization procedure, how it is used, and what results to expect. What are uterine fibroids? Fibroids are benign tumors. Benign means that they are not cancer. Uterine fibroids occur in the muscle tissue of the wall of the uterus. They are not harmful, but they may be painful. They can also cause heavy menstrual bleeding or pressure on the bladder and bowel. What is uterine fibroid embolization? In embolization, a doctor injects a material into a blood vessel to block blood flow. Uterine fibroid embolization (UFE) is a way to treat fibroids DRAFTof the uterus without surgery. UFE uses X-rays to guide a catheter (tiny tube) into the arteries that feed blood to the fibroid. Small particles are then injected to block blood flow. With its blood supply cut off, the fibroid no longer receives oxygen and nutrients. The fibroid stops growing and begins to shrink. Most times, this eases symptoms. UFE is done by an interventional radiologist, a doctor with special training to do this procedure. It is much easier on the body than open surgery, which uses a scalpel to make an incision in the body. We do not yet know how UFE affects fertility. Because of this, the best candidate for During UFE, small particles are injected UFE is a woman with fibroid into blood vessels to block blood flow to tumors who no longer wishes the fibroid. to become pregnant. Talk with your doctor about the benefits and risks of your having UFE. -
Subtraction CTA: an Alternative Imaging Option for the Follow-Up of Flow-Diverter-Treated Aneurysms?
Published October 4, 2018 as 10.3174/ajnr.A5817 ORIGINAL RESEARCH INTERVENTIONAL Subtraction CTA: An Alternative Imaging Option for the Follow-Up of Flow-Diverter-Treated Aneurysms? X M.P. Duarte Conde, X A.M. de Korte, X F.J.A. Meijer, X R. Aquarius, X H.D. Boogaarts, X R.H.M.A. Bartels, and X J. de Vries ABSTRACT BACKGROUND AND PURPOSE: This was a pilot study to explore the diagnostic accuracy and safety of subtraction CTA combined with a single-energy metal artifact reduction algorithm (SEMAR) compared to DSA for the evaluation of intracranial aneurysm occlusion after flow diverter treatment. MATERIALS AND METHODS: We included patients treated with a flow diverter for an unruptured intracranial aneurysm between November 2015 and November 2016. The patient cohort comprised 2 groups: those who underwent follow-up imaging 1 month after flow-diverter treat- ment and those with a known residual intracranial aneurysm after flow diverter treatment who underwent imaging at regular follow-ups. Full-brain subtraction CTA was performed on a 320–detector row CT system. A low-dose non-enhanced volume acquisition was followed by a contrast-enhanced volume CTA. Iterative and noise-reduction filters, SEMAR, and SURESubtraction algorithms were applied. DSA was performed on a flat panel C-arm angiography system. Standard posteroanterior, lateral, 3D, and detailed 2D acquisitions were performed. Imaging was independently scored by 2 clinicians. Aneurysm occlusion (Raymond scale) was our primary outcome parameter. RESULTS: Thirteen intracranial aneurysms were evaluated with subtraction CTA and DSA. Nine aneurysm remnants were demonstrated by both subtraction CTA and DSA. -
UNIVERSITY of CALIFORNIA SAN DIEGO Live-Cell in Vitro Aneurysm
UNIVERSITY OF CALIFORNIA SAN DIEGO Live-Cell In Vitro Aneurysm System using 3D Printing Athesissubmittedinpartialsatisfactionofthe requirements for the degree Master of Science in Bioengineering by Quanyou Shi Committee in charge: Shu Chien, Chair Alexander Arash Khalessi Geert W Schmid-schoebein Dayu Teng 2021 Copyright Quanyou Shi, 2021 All rights reserved. The thesis of Quanyou Shi is approved, and it is acceptable in quality and form for publication on microfilm and electronically: Chair University of California San Diego 2021 iii TABLE OF CONTENTS SignaturePage ..................................... iii TableofContents ................................... iv ListofFigures ..................................... v Acknowledgements................................... vi AbstractoftheThesis ................................. vii Introduction ...................................... 1 MaterialsandMethods ................................ 3 Results ......................................... 9 Discussion........................................ 16 Results ......................................... 18 References........................................ 19 iv LIST OF FIGURES Figure 1: 3D design of the aneurysm vessels. 4 Figure 2: Block diagram for the in-vitro perfusion system. 6 Figure 3: Diagram for aneurysm vessel flow chamber. 7 Figure 4: Computational simulation and flow validation for the parallel-plate aneurysm vessel. 10 Figure 5: Computational simulation and flow validation for the half-round aneurysm vessel. 11 Figure 6: Full vessel scan and zoomed-in images at the vessel center region at Day 0, 4, 6, and 8. 13 Figure 7: Zoomed-in images at the Proximal and distal aneurysm neck region at Day 0, 4, 6, and 8. 14 Figure 8: Zoomed-in images at the aneurysm belly region at Day 0, 4, 6, and 8. 15 Figure 9: In vitro live-HUVECs images overlaid with the shear stress simulation. 18 v ACKNOWLEDGEMENTS I would like to express my deepest gratitude to my committee chair, Dr. Chien, and my advisor, Dr. -
Flow Diversion Stents Provide Treatment Option for Unruptured Cerebral Aneurysms
Flow diversion stents provide treatment option for unruptured cerebral aneurysms Solution for complex brain aneurysms Flow diversion represents a significant advance in the treatment of unruptured brain aneurysms, says Geoffrey P. Colby, MD, PhD, associate professor of neurosurgery and radiology at UCLA. “Instead of just blocking blood flow into an aneurysm, it also accomplishes a rebuilding of the blood vessel wall,” Dr. Colby says. “It’s the only technique that truly addresses the root cause of the aneurysm — which is the weakness of the blood vessel wall.” UCLA has participated in post-approval studies of flow diversion and has gained About 35,000 Americans suffer potentially life-threatening cerebral aneurysm valuable experience in using the ruptures each year. A much larger number of people develop unruptured aneurysms device, says Gary Duckwiler, — areas of weakness within a major blood vessel in the brain that bulge and are at MD, chief of diagnostic and interventional radiology. risk of rupture and hemorrhage. Unruptured aneurysms can remain asymptomatic and undiagnosed. In some cases, the problem is discovered incidentally, when “As our comfort level has a patient undergoes imaging for generalized neurological complaints, such as gotten higher with the device, headache or dizziness. we’ve extended the use of this into other subtypes of Treatment decisions surrounding unruptured intracranial aneurysms can be aneurysms,” Dr. Duckwiler says. confounding. The decision to treat the aneurysm depends on several factors, “It’s been a tremendous boon to including the size, shape and location of the lesion and the patient’s family difficult aneurysms for which history and personal health, including a history of hypertension, smoking we previously didn’t have any good solutions.” or other conditions. -
Pulmonary Embolism A-Nd Thrombosis R
Postgrad Med J: first published as 10.1136/pgmj.38.435.13 on 1 January 1962. Downloaded from POSTGRAD MED. J. (I962), 38, 13 PULMONARY EMBOLISM A-ND THROMBOSIS R. MARSHALL, M.D., M.R.C.P. Nuffield Department of Surgery, Radcliffe Infirmary, Oxford SUDDEN death following a call for a bedpan is a chest pain and ECG changes when the balloon classical mode of presentation of pulmonary em- was inflated in a smaller artery (Brofman, Charms, bolism, but it is probable that cases of this severity Kohn, Elder, Newman and Rizika, I957). On the form only a small proportion of the total. Pul- other hand, it is a common practice to impact the monary embolism may be caused by blood clot, tip of a cardiac catheter in branches of the pul- fat, cells or foreign bodies, but most commonly by monary artery of about 2 mm. diameter with no blood clot. ill effects. In spite of the undoubted ability of emboli to produce reflex effects under certain cir- cumstances, there is a growing body of evidence The Physiological Effects that the effects of pulmonary embolism by inert The physiological effects ofpulmonary embolism particles are produced by the magnitude of the depend upon the size and number of the emboli mechanical blockage of the pulmonary vessels and and they may produce these effects either by are not dependent upon the size of the emboli or mechanical blockage of the circulation when they reflex vasoconstriction (Daley, I957; McEvoy, are of sufficient size or number, or by the initiation Harder and Dale, 1958; Williams, 1956).