Complete Visual Recovery after Mycotic Aneurysm Embolization Complicated by Cavernous Sinus Thrombophlebitis

A 62-year-old woman has been suffered from cavernous sinus thrombophlebitis which was confirmed by four-vessel angiography, orbit magnetic resonance imaging, and blood culture. Three weeks after recovery of cavernous sinus thrombophlebitis, right eye proptosis and complete third, fourth, and sixth cranial nerve palsies developed. Best-corrected visual acuity decreased to 20/70 in the right eye. Repeat magnetic resonance imaging demonstrated a 1.5-cm-sized mass in the right cavernous sinus, suspicious for mycotic aneurysm. Amphotericin B supplementation was begun and was followed by successful transarterial Guglielmi detachable coil embolization. Four months later, extraocular movement was normalized, and visual acuity improved to 20/25 in the right eye.

Persistent Trigeminal Artery Aneurysm Treated with Guglielmi Detachable Coils

A persistent trigeminal artery(PTA) is a rare embryonic channel between internal carotid artery and basilar artery. It can be frequently associated with intracranial aneurysms. But an aneurysm arising from the junction of PTA and internal carotid artery(ICA) is extremely rare. The authors report a case of unruptured right ICA-PTA aneurysm treated with Guglielmi detachable coils successfully. Pathogenesis for the aneurysm formation at the junction of ICA and PTA is discussed.

GDC Embolization of Basilar Bifurcation Aneuryms; Consideration of Posterior Cerebral Artery Occlusion

OBJECTIVE: To access the risk factors of posterior cerebral artery(PCA) occlusion during endovascular treat-ment of basilar bifurcation aneurysm and importance of collateral circulation through posterior communicating artery(PCoA) after PCA occlusion, the authors review the results of 25 patients with basilar bifurcation aneurysms treated with Guglielmi detachable coils(GDCs). METHODS: Male to female ratio was 1: 3.2(6: 19) and the mean age of this group was 54. Nineteen patients were presented with subarachnoid hemorrhage, 1 patient had neurologic deficits of hemiplegia and dysarthria, and 5 patients had incidental aneurysms with headache and dizziness. All patients underwent GDC embolization and their clinical results were analyzed. RESULTS: Seven of nine patients who resulted in PCA occlusion had a collateral flow from the anterior circulation through PCoA. Six patients had a PCoA larger than 1mm and they had no symptoms of ischemia after PCA occlusion. One patient who had a PCoA with 0.53mm in diameter had transient ischemic symptoms. The PCA arouse from the aneurysm neck in seven patients, and six of them resulted in PCA occlusion. Four of five patients who had aneurysms with broad neck(<4mm) resulted in PCA occlusion. CONCLUSION: The aneurysm with either broad neck or PCA arising from the aneurysm neck have a high risk of PCA occlusion. After PCA occlusion, significant blood flow from anterior circulation through the PCoA larger than 1mm in diameter can minimize the ischemic result in PCA territories.

Emergency Endovascular Treatment of Internal Carotid Artery Injury During a Transsphenoidal Approach for a Pituitary Tumor: Case Report

Carotid artery injury is a very rare, but life threatening complication that can occur during a transsphenoidal approach. We experienced one case of carotid artery injury during a transsphenoidal pituitary tumor surgery. The patient was immediately treated by a balloon occlusion and complete packing of the cavernous carotid artery using Guglielmi detachable coils (GDCs) and the rest of the tumor was removed after the carotid occlusion. The patient recovered without showing any neurological deficits.

Direct Electrothrombosis of a Pseudoaneurysm after Obliteration of a Carotid Cavernous Fistula:Treatment with Guglielmi Detachable Coils: Case Report

Carotid-cavernous fistulaes are traumatic in origin in over two thirds of all cases. Occlusion of these lesions by endovascular techniques or open surgical approaches is usually indicated. The current treatment of choice is occlusion by use of the intraarterial detachable balloon technique. Pseudoaneurysm, one of the complications after employment of the detachable balloon technique, develop at the balloon placement site after balloon deflation. Its incidence is approximately 44% in the literature. But peudoaneurysms are difficult to treat using endovascular techniques with detachable balloon or coils. The authors report that one case with a pseudoaneurysm who had abducens nerve palsy was treated successfully using Guglielmi detachable coils(GDC). His 6th cranial nerve palsy was improved within 6 weeks.

Endovascular stenting for treatment of complex intracranial aneurysms: preliminary outcome / 介入放射学杂志

Objective To summarize the technique and efficiency of combined endovascular stenting and Guglielmi detachable coils (GDC) packing for the treatment of intracranial wide-necked bifurcation aneurysms and recanalized aneurysms.Methods The coronary stents were implanted across the necks of 5 intracranial wide-necked aneurysms (two at bifurcation of ICA, one at basilar artery and two recanalized PcoA aneurysms). The porous stents covered the ostia of vital side branches and perforating vessels in three cases. Microcatheters were introduced into the aneurysmal sac through the stent mesh and then followed by GDCs embolizing the aneurysms. Results The stents were deployed in parent artery in all cases. Total occlusion was obtained in 4 cases, while more than 90% in one case with patency of the parent arteries and vital perforating arteries. Follow-up angiography performed in all patients 3-6 months later revealed no intra-stent stenosis. All the patients recovered well except Ⅲ nerve palsy in one patient which diminished 3 months later.Conclusion Endovaseular therapy combined stent implantation and microcoil placement maybe a valid alteration for the treatment of wide-necked bifurcation aneurysms and recanalized aneurysms, which shows promise clinical application in the future. The ostia of vital side branches covered with stents showed no effect on hemodynamics.

Clinical study of endovascular stenting combined with coiling for treatment of intracranial wide-necked aneurysms / 介入放射学杂志

Objective To report experience of endovascular stenting combined with coiling for intracranial wide necked aneurysms and to investigate its indication, technical tip, prevention and treatment of complication, safety and efficacy. Methods The coronary stents were implanted across the neck of intracranial wide necked aneurysms in 105 patients (78 located in anterior circulation and 27 in posterior circulation). Microcatheters were introduced into the aneurysm sac through stent mesh. GDCs were used to embolize the aneurysms . Results The stents were deployed in 104 patients and total occlusion was obtained in 80 cases and more than 90% in 24 cases. The patients recovered well with patency of the parent arteries except one with cerebral infarction and another with carotid dissection during the procedure. The stent collapsed in one case after coiling.No re bleeding or symptom related to thrombosis occurred during clinical follow up for 3 28 months. Follow up angiogram in 62 cases showed no recanalization in all patients, but two with further thrombosis and one with mild stenosis in proximal segment of the stent. Conclusions Endovascular therapy combined stent implantation and microcoil placement would be a valid alteration for the treatment of complicated intracranial aneurysms. However, long term outcome need further study.

Endovascular treatment of intracranial aneurysms with stents and coils / 介入放射学杂志

Objective Endovascular stenting or combined stenting and Guglielmi detachable coils packing for the treatment of intracranial fusiform and wide necked aneurysms were reported to access the feasibility of the procedures.Methods The coronary stents were implanted across the neck of 3 vertebral fusiform aneurysms and 6 wide necked aneurysms. Microcatheters were introduced into the aneurysm sacs through stent mesh, and finally GDCs were used to embolize the aneurysms. Results The stents were precisely deployed resulting in total occlusion of 7 cases with more than 90% occlusion in 2 cases. All patients recovered well with patency of the parent arteries.Conclusions Endovascular therapy with combined stent implantation and microcoil placement maybe a valid alteration for the treatment of intracranial fusiform or wide necked aneurysms.

Radiographic follow up results of endovascular stenting combined with coiling on treatment of intracranial wide-necked aneurysms / 介入放射学杂志

Objective The radiographic outcomes of endovascular stenting combined with coiling for treating intracranial wide necked aneurysms were summarized for investigating the efficacy of this proceduce. Methods sixty two patients with intracranial wide necked aneurysms were treated with combined stenting and coiling proceduce and all were undergoing clinical and angiographic follow up after the initial treatment. Results The stents were deployed in all aneurysms and total occlusion was obtained in 47 cases and subtotal occlusion in 15 cases. Follow up angiograms during 1 6 months showed complete obliteration in 57 cases, neck remnant with further thrombosis in 4 cases, recanalization in one case which needed another occlusion. 12 37 months follow up angiogram in 43 cases suggested total occlusion in 40 cases with two neck remnant and one recanalization. Conclusions Endovascular stent placement changes flow characteristics and facilitate thrombosis inside the aneurysm pouch resulting in radiographically healing by promoting endothelization at aneurysmal neck.