ABSTRACT
OBJECTIVE: It is challenging to safely treat blood blister-like aneurysms (BBAs) of the internal carotid artery. Endovascular surgery has been reported, but the optimal strategy is yet to be established. We report our endovascular treatment strategy using the Low-profile Visualized Intraluminal Support (LVIS) stent. METHODS: Twelve patients with ruptured BBAs including 1 patient with 2 separate aneurysmal bulges were treated from December 2017 to January 2020. Single LVIS stent-assisted coil embolization was performed as the initial treatment. If the coil could not be placed in the aneurysm, or follow-up angiography showed persistent filling or regrowth of the aneurysm, a second LVIS stent was deployed as an overlapping stent. Clinical characteristics, treatment details, and clinical outcomes were retrospectively examined. RESULTS: Single stent-assisted coiling was performed in 8 patients (69%), 2 overlapping stents with coiling in 1 (8%), a single stent in 2 (15%), and 2 overlapping stents in 2 (15%). Three patients with persistent filling or regrowth of the aneurysm were re-treated with overlapping stents. Follow-up angiography confirmed complete occlusion in 12 aneurysms (92%). No re-rupture occurred. Postoperative symptomatic ischemia was confirmed in 4 patients (33%), and all 4 patients suffered severe subarachnoid hemorrhage. Modified Rankin scale was 0-2 in 8 patients (67%). CONCLUSIONS: LVIS stent-assisted coil embolization is effective in preventing re-rupture of BBAs. However, the morphology of the aneurysm may change within a short period, so careful angiographic follow-up is needed. Appropriate preoperative antiplatelet administration and optimal timing of the treatment may reduce the risk of postoperative ischemic complication.
Subject(s)
Aneurysm, Ruptured/surgery , Aortic Dissection/surgery , Carotid Artery Injuries/surgery , Carotid Artery, Internal, Dissection/surgery , Endovascular Procedures/methods , Intracranial Aneurysm/surgery , Stents , Adult , Aged , Aged, 80 and over , Carotid Artery Diseases/surgery , Carotid Artery, Internal/surgery , Female , Humans , Male , Middle Aged , Rupture, SpontaneousABSTRACT
We report a 29-year-old man with a rare left lumbar subcutaneous cold abscess complicated by tuberculous spondylitis during the treatment of pulmonary tuberculosis. Pulmonary tuberculosis was rapidly improved by anti-tuberculous drugs, however curative operation for tuberculous spondylitis was necessary after 18 months because tuberculous spondylitis was overlooked. Imaging techniques are important in helping to establish a diagnosis of tuberculous spondylitis. It should be stressed that a high clinical index of suspicion for tuberculosis is needed to correctly diagnose this disease.
Subject(s)
Abscess/etiology , Spondylitis/microbiology , Tuberculosis, Osteoarticular/complications , Tuberculosis, Pulmonary/complications , Adult , Humans , Magnetic Resonance Imaging , Male , Spondylitis/complications , Spondylitis/diagnosis , Spondylitis/surgery , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/surgerySubject(s)
Adaptor Proteins, Signal Transducing , Genetic Code/genetics , Memory/physiology , Animals , Carrier Proteins/physiology , Cloning, Molecular , Drosophila Proteins , Homeodomain Proteins/physiology , Humans , Protein Kinase C/physiology , RNA Interference , Signal Transduction/physiology , Synapses , Transcription FactorsABSTRACT
A case of osteochondral fracture of the triquetrum associated with pisiform subluxation in a 21-year-old woman is described. The fracture was diagnosed by tomography and magnetic resonance imaging. We consider that the fracture resulted from shear force produced by the pisiform subluxation. Excision of the pisiform provided complete relief of pain and a good functional result.
