Pericallosal Aneurysms: Effectiveness of Endovascular Management

Objective Clarify the safety and efficacy of the endovascular treatment of distal anterior cerebral artery (DACA) aneurysms, reporting outcomes of the aneurysms coiled in our service were compared with series of microsurgical treatment. The impact of embolization on ruptured or unruptured aneurysms remains controversial according to the current data, considering aneurysm from this topography should be aggressively treated due to their high incidence of rupture, currently there is a tend to prefer endovascular treatment. Methods We conducted a retrospective cohort study with 1092 patients admitted with cerebral aneurysm from October 2005 to March 2015 in our service. There were 31 cases of DACA aneurysms treated with the endovascular technique. These were compared with same topography aneurysms underwent to clipping. Results A total of 21 (67%) of 31 cases presented with ruptured aneurysms, 13 (59%) suffered clinical or radiological vasospasms, with modified Rankin Scale (mRS) scores of 3­5 in 7 patients (31%), and 4 deaths (mRS 6), reaching 92% of occlusion at one year. Conclusion Endovascular approach is associated with high angiographic occlusion rates and security.

Objetivo Para esclarecer a segurança e eficácia do tratamento endovascular dos aneurismas distais da artéria cerebral anterior distal (DACA), foram relatados os resultados de aneurismas embolizados em nosso serviço e comparados com séries de tratamento microcirúrgico. O impacto da embolização em aneurisma roto ou não roto permanece controverso com base nos dados atuais, considerando que o aneurisma dessa topografia deve ser tratado agressivamente devido à elevada incidência de ruptura, há uma tendência em preferir tratamento endovascular. Métodos Realizamos um estudo retrospectivo de 1092 pacientes admitidos com aneurisma cerebral entre Outubro de 2005 a Março de 2015 em nosso serviço. Haviam 31 casos de aneurisma da DACA tratados com a técnica endovascular. Estes foram comparados com aneurismas da mesma topografia tratados através de microcirurgia. Resultados Um total de 21 (67%) dos 31 pacientes apresentaram aneurisma roto, 13 (59%) sofreram vasoespasmo clínico ou radiológico, desfecho Escala de Rankin modificada (ERm) 3­5 em 7 (31%) pacientes e 4 mortes (ERm 6). A taxa de oclusão imediata foi de 96% e a taxa de oclusão em um ano de 92% com apenas uma recanalização. Conclusão A abordagem endovascular está associada com altas taxas de oclusão angiográfica e segurança no procedimento.

A Case of Left Iliac Vein Thrombosis with May-Thurner Syndrome / 대한혈액학회지

Iliac vein compression syndrome (May-Thurner syndrome) is caused by compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery, resulting in impaired venous return and left iliofemoral thrombosis. We experienced a case of a 68-year-old woman who showed sudden left lower extremity edema. By the Doppler sonogram, deep vein thrombosis of left lower extremity was detected. It was involved only left side and extended to iliac vein level. In the venogram, spur like projection was noticed on left iliac vein. Through endovascular thrombectomy, thrombolysis and angioplasty, venous return was completely restored. We report a case of May-Thurner syndrome who was treated with various endovascular management successfully.

Endovascular Treatment of Bilateral Spontaneous Carotid-cavernous Fistulas

The authors report a case of a 46-year-old woman with bilateral spontaneous carotid-cavernous fistulas(CCFs). The patient was treated by endovascular management via multiple trans-arterial and trans-venous routes. Left side CCF was embolized completely via surgically exposed superior ophthalmic vein route. Right side lesion was tried by multi-modality endovascular trajectories and achieved partial thrombosis by trans-arterial approach. The follow-up angiogram two months after the last embolization showed a complete bilateral elimination of fistulas. Embolization of bilateral complex CCFs can be achieved by multiple trans-arterial and trans-venous routes, including direct surgical exposure of superior ophthalmic vein.