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Objective To discuss the application of Chaperon guiding catheter system in endovascular treatment of intracranial aneurysms. Methods A total of 20 patients with intracranial aneurysms were enrolled in this study. The patients hadⅡorⅢtype of aortic arch (n=11) or sclerotic plague at the orifice of internal carotid or vertebral artery (n = 9). Endovascular embolization of the intracranial aneurysm was carried out in all patients. By using Cordis guiding catheter system the catheter was placed into the target artery. Chaperon guiding catheter system was used during the procedure in order to determine whether the Chaperon guiding catheter could be smoothly placed into the target artery or not. Results When the Chaperon guiding catheter system was employed in the endovascular procedure, the difficulties of catheterization caused by the distortion of the aorta or by the plagues on the walls of arteries could be basically overcome. The Guiding catheter could be smoothly placed into the target arteries. Conclusion The Chaperon guiding catheter system can be successfully used in the endovascular treatment for the intracranial aneurysms, especially when the patient has tortuous aorta or there is sclerotic plague on the artery wall. (J Intervent Radiol, 2014, 23:281-283).
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Objective To explore and evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB Revascularization Device in acute basilar artery occlusion.Methods Nine patients with basilar artery occlusion were treated with direct thrombectomy by using Solitaire AB stent retrievers between August 2010 and October 2012.Stent angioplasty was performed for patients with serious residual stenosis.Neurologic status was evaluated before and after treatment according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scales (mRs).Neurologic status was evaluated after treatment according to the NIHSS and mRs 6 months after stent placement.Stent patency at follow-up was assessed by MR angiography,or DSA 6 months after stent placement.Results Successful revascularization was achieved in all patients.Stenting and angioplasty were performed in 6 patients with serious residual stenosis.The complication of cerebral hemorrhage did not occur in any patient.Acute thrombosis happened in one patient one day after procedure.Emergent angiography showed re-occlusion of basilar artery.Intraarterial thrombolytic therapy was given,and reperfusion was achieved,but the patient died 6 days later.One patient developed coma at 4th month of follow-up.MRA showed acute basilar artery occlusion again and magnetic resonance imaging showed extensive ischemic damage of the brainstem.The patient died during the conservative treatment period.The mean NIHSS scores were 2.4 ± 1.2 at discharge.The mRs scores were 0 in 2 patients,1 in 4 patients,2 in one patient,and 3 in 1 patient at discharge.Conclusion Mechanical thrombectomy with the Solitaire AB stent in acute basilar artery occlusion is relatively safe and effective.
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Objective To evaluate the effect of endovascular embolotherapy treatment of carotid cavernous fistulas(CCF) via superior ophthalmic vein(SOV).Methods From June 1996 to June 2006,a total of 32 patients(16 female) with complex CCF underwent endovascular embolotherapy treatment through the SOV.All of the patients visited doctor due to ocular signs and symptoms.Nine patients with direct CCF had previously undergone partial arterial balloons embolotherapy.The other 23 patients were hard mater CCF,and of which 3 had underwent NBCA,embolotherapy with line section or PVA particle.In the angiographic suite all patients underwent general anesthesia,SOV was catheterized through the eyebrow incision.Cavernous sinus was packed with free coils,detachable coils or balloons and NBCA.Results Complete embolism of the arteriovenous shunt was achieved in 81.3%(26/32).A minor residual shunt(without cortical or ocular drainage) remained in 12.5%(4/32).Only SOV was occluded in 6.2%(2/32).All patients were clinical improvement without complications.No death and permanent disability occurred.No recurrence was observed during follow-up of mean time of 3.5 years in 22 outpatients.Conclusion The operative approach to SOV is straightforward and several kind of embolic materials can be used to embolize the cavernous sinus.Endovascular occlusion of cavernous sinus through the SOV is an efficient and safe treatment in CCF.
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Objective To evaluate the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis of middle cerebral artery (MCA). Methods Thirty-two cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively [average (49±19) years old, 13 women]. All patients underwent angioplasty and stenting with the Gateway balloon-Wingspan stent system. After 6 months, all patients were followed up by telephone or clinic, and advised followed up with DSA or TCD. Results Thirty-two patients were successfully stented during the first treatment session. The mean degree of stenosis reduced from (76.5±15.4)% to (19.3±9.2)%. The number of complicating subarachnoid hemorrhage was one, and occlusion occurred on one patients related to balloon angioplasty. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 32 available patients. Cerebral hemodynamics using transcranial Doppler monitoring were normal in 19 follow-up patients. Six-month angiographic follow-up was obtained in 5 patients, demonstrating good patency in 5 stenting vessels. The other patients refused to perform TCD or DSA. Conclusions Wingspan stent for symptomatic stenosis of middle cerebral artery appears to be a safe and feasible under strict control of periperformeral project. However further study is needed to evaluate the long-term effect.