ABSTRACT
There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist.
ABSTRACT
OBJECTIVE: Endovascular treatment of vertebral intradural dissecting aneurysms is complex and requires different strategies for each case. The current study aims to classify these aneurysms for an easy selection of optimal strategies for endovascular therapy. MATERIALS AND METHODS: This study is a retrospective evaluation of 10 patients harbouring a vertebral intradural dissecting aneurysm (including 6 female and 4 male patients). The clinical, procedural, and angiographic data were evaluated. RESULTS: Nine patients presented with acute subarachnoid hemorrhage and 1 with acute-onset headache. The aneurysms were classified into two types, depending on the developmental state of the contralateral vertebral artery: Dominant (A) and hypoplastic (B). Type A (n = 7) group was further divided into three subtypes on the basis of location of the aneurysm in relation to the posterior inferior cerebellar artery (PICA): aneurysm proximal to the PICA, Type I (n = 3); involving the PICA, Type II (n = 2); and, distal to the PICA, Type III (n = 2). Internal trapping was done for 4 patients in this group, 2 patients with aneurysm involving the PICA underwent proximal occlusion and 1 patient underwent stent-assisted coiling since he refused to undergo vertebral artery sacrifice. B Type patients (n = 3) were treated with reconstructive endovascular management. No symptomatic complication was seen in the patients with trapping. Antiplatelet medication-related complication was seen in 2 patients who underwent stent-assisted coiling. Clinical outcome at the time of discharge was good [modified Rankin score (mRS) 0-2] in 8 and poor (mRs >2) in 2 patients. At follow-up visit, one patient had developed severe cognitive impairment but was independent in activities of daily living. CONCLUSION: The classification of vertebral artery aneurysms based on their location and on the status of the contralateral vertebral artery appears to be an effective method for the selection of safe and appropriate endovascular therapy.
Subject(s)
Embolization, Therapeutic/methods , Endovascular Procedures/methods , Stents , Subarachnoid Hemorrhage , Vertebral Artery Dissection , Dura Mater , Female , Follow-Up Studies , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/adverse effects , Retrospective Studies , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/therapy , Treatment Outcome , Vertebral Artery Dissection/complications , Vertebral Artery Dissection/diagnosis , Vertebral Artery Dissection/pathology , Vertebral Artery Dissection/therapyABSTRACT
Transcatheter arterial chemoembolization (TACE) is the most widely used treatment modality for patients with hepatocellular carcinoma who are not eligible for surgery. Selective tumor embolization is very important, more so in patients with mild to moderate liver cell failure, but determining feeder vessels could be difficult with two-dimensional angiogram alone. Cone beam computed tomography and detection software are available for intraprocedural accurate feeder vessel detection; however, these facilities are not widely available. We have evaluated and successfully applied a very simple technique using only a portable ultrasonography machine to ensure superselective feeder cannulation prior to embolization.
