The pCONUS2 and pCONUS2 HPC Neck Bridging Devices : Results from an International Multicenter Retrospective Study.

INTRODUCTION: Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. METHODS: We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. RESULTS: We identified 55 patients with 56 aneurysms, median age 63 years (range 42-78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2-21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6-14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5-3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3-36 months) demonstrated adequate occlusion of 83.4% of aneurysms. CONCLUSION: The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.

Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro / Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center

Objetivos. Presentamos los resultados a corto y largo plazo de una serie de pacientes con estenosis arteriales intracraneales (EAIC) sintomáticas tratados en nuestro centro mediante angioplastia y endoprótesis. Material y métodos. Revisión de pacientes con estenosis intracraneales > 50% sintomáticas tratados en nuestro centro mediante angioplastia y/o colocación de endoprótesis. Se recogieron los datos demográficos y los factores de riesgo vascular (hipertensión, diabetes, dislipemia, cardiopatía isquémica). Todas las lesiones tratadas se caracterizaron por su localización, grado y longitud de la estenosis. El grado de estenosis se calificó como moderado (50-70%) o grave (> 70%). En el seguimiento se evaluaron los accidentes cerebrovasculares, episodios de cardiopatía isquémica o fallecimientos ocurridos durante los 30 primeros días y en el seguimiento posterior. Resultados. Entre 2006 y 2010 se trataron 26 pacientes (21 varones y 5 mujeres) con edades comprendidas entre 44 y 79 años (media: 63 años), con 29 lesiones intracraneales. El procedimiento endovascular se realizó con éxito (angioplastia + endoprótesis) en 23 casos (92,0%). En los 30 primeros días postintervención se produjeron tres (11,5%) efectos adversos de origen vascular: un ictus, una hemorragia y un fallecimiento por trombosis de la endoprótesis. El seguimiento a largo plazo se ha realizado sobre 25 pacientes (5-46 meses). No se han detectado recurrencias de la sintomatología. Conclusión. El tratamiento endovascular de las EAIC es técnicamente factible. Las complicaciones del procedimiento a corto plazo tienen una prevalencia alta. No se ha detectado recurrencia de la sintomatología a largo plazo(AU)

Objectives. We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. Material and methods. We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. Results. Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty + stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. Conclusion. Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up(AU)

[Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center]. / Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro.

OBJECTIVES: We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. MATERIAL AND METHODS: We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. RESULTS: Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty+stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. CONCLUSION: Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up.

Evolución a largo plazo de la estenosis carotídea tratada endovascularmente: estudio prospectivo en una unidad neurovascular / Long-term development of carotid stenosis treated by endovascular means: a prospective study in a neurovascular unit

Objetivo. Aun hoy, a diferencia de la endarterectomía, la evolución a largo plazo en la angioplastia carotídea no está bien definida. El objetivo es describir la evolución a corto y largo plazo y la tasa de reestenosis de una serie consecutiva de pacientes con estenosis de carótida sometidos a tratamiento endovascular en el Hospital Universitario La Fe, diferenciando entre pacientes con y sin síntomas. Pacientes y métodos. Desde 1999 hasta 2010 se incluyeron 426 pacientes a los que se les realizó angioplastia carotídea (el 25,5% eran pacientes asintomáticos). Se llevó a cabo seguimiento clínico a 374 pacientes. Fueron visitados anualmente, y cada año se les realizó estudio neurosonológico. Se recogieron las complicaciones durante los 30 primeros días y las complicaciones a largo plazo; se recogió la tasa de reestenosis en el seguimiento y se valoraron las posibles diferencias entre pacientes con y sin síntomas. Resultados. La morbimortalidad en el primer mes fue del 4,2% (4,4% en pacientes sintomáticos y 3,8% en pacientes asintomáticos). El seguimiento medio fue de 55 meses: un 8% de pacientes presentó ictus, un 11% sufrió un infarto de miocardio y un 24,3% falleció, sin diferencias significativas entre los pacientes con y sin síntomas. La tasa de reestenosis fue del 17,3% a los cinco años, un 7,5% igual o superior al 50%, y de ellas, en el 1,1% fueron sintomáticas. Cinco pacientes con reestenosis significativa fueron tratados con éxito con técnicas endovasculares. Conclusiones. La angioplastia carotídea es una técnica efectiva y segura en manos experimentadas; nuestros resultados son buenos, tanto a corto como a largo plazo, con una baja tasa de reestenosis. En caso de producirse esta última, el intervencionismo vascular es seguro y eficaz (AU)

Aims. Even today, unlike endarterectomy, long-term development in carotid angioplasty has still not been well defined. The aim of this study is to describe both the short- and long-term development and the rate of restenosis in a consecutive series of patients with carotid stenosis who underwent endovascular treatment at the Hospital Universitario La Fe; a distinction is made between patients with and without symptoms. Patients and methods. From 1999 to 2010, 426 patients were submitted to a carotid angioplasty (25.5% were asymptomatic patients). Clinical follow-ups were conducted in the case of 374 patients. They had annual check-ups and every year a neurosonological study was performed. The aim was to determine what complications occurred during the first 30 days, as well as the long-term complications, to establish the rate of restenosis and to evaluate possible differences between patients with and without symptoms. Results. The morbidity and mortality rate in the first month was 4.2% (4.4% in symptomatic patients and 3.8% in asymptomatic patients). The mean follow-up time was 55 months: 8% of patients presented strokes, 11% suffered from myocardial infarct and 24.3% died, with no significant differences between patients with or without symptoms. The rate of restenosis was 17.3% at five years, 7.5% equal to or above 50% and, of those, 1.1% were symptomatic. Five patients with significant restenosis were successfully treated with endovascular techniques. Conclusions. Carotid angioplasty is an effective, safe technique in the hands of an experienced professional; our findings are good, both in the short and the long term, with a low rate of restenosis. If this latter condition occurs, vascular intervention techniques are safe and efficient (AU)

[Terson syndrome associated with a carotid-ophthalmic giant aneurysm]. / Síndrome de Terson asociado a aneurisma carótido-oftálmica gigante.

UNLABELLED: PURPOSE/MATERIAL AND METHOD: A case of a 42 year-old woman presenting headache, vomiting and loss of consciousness of sudden onset. Upon testing right eye presented amaurosis while left eye showed a visual acuity of 20/50. RESULTS/CONCLUSION: Brain angiography showed a right sided giant carotid aneurysm at the ophthalmic artery area. Globe fundus in left eye showed vitreal and intra-retinal hemorrhage appearing in retinal posterior pole and periphery of the retina. Subarachnoidal hemorrhage accompanied by intra-vitreal bleeding is known as Terson's Syndrome. Peculiarities of this clinical case are discussed in this paper.

Síndrome de terson asociado a aneurisma carótido-oftálmica gigante / Terson's syndrome referred from giant aneurysm in carotid and ophthalmic arteries

Objetivo/Métodos: Presentamos el caso de una paciente de 42 años con cefalea, vómitos y pérdida de conciencia de instauración súbita. Este cuadro fue debido a una hemorragia subaracnoidea secundaria a la ruptura espontánea de un aneurisma. Tras recuperar la conciencia, la agudeza visual de su ojo derecho era amaurosis mientras que la de su ojo izquierdo (OI) era de 20/50.Resultados/Conclusión: Mediante arteriografía cerebral se detectó un aneurisma carótido-oftálmico gigante derecho. Fundoscópicamente se observó en el OI una hemorragia intravítrea con hemorragias retinianas dispersas tanto en el polo posterior como en la periferia de la retina. La asociación de hemorragia subaracnoidea con intravítrea es conocida como síndrome de Terson. Se discuten las peculiaridades del caso con síndrome de Terson (AU)

[Direct carotid-cavernous fistulas: endovascular treatment using a detachable balloon]. / Fístulas carotidocavernosas directas: tratamiento endovascular mediante balón desprendible.

INTRODUCTION: Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the internal and/or external carotid artery. They may be spontaneous or acquired. Two basic types are distinguished as a function of the aetiology, clinical features and treatment. The direct type is usually due to trauma while the indirect is of varied aetiology. CLINICAL CASE: We present a series of seven cases of direct carotid-cavernous fistulas, four post-traumatic and three spontaneous, with initial symptoms of ocular involvement and ophthalmoparesia predominantly. All were treated, in our hospital, by embolization with a detachable balloon in the venous variant of the fistula in six cases and by carotid occlusion in one case. Only one severe complication due to distal embolization occurred. CONCLUSIONS: It is necessary to consider the diagnosis of carotid-cavernous fistulas in patients complaining of acute alterations of ocular motility, headache and/or other ocular symptoms, especially when there is a clinical history of head injury. There should be minimal delay between diagnosis and treatment since there is a high risk of hemorrhage and irreversible sequelae caused by alteration of the venous drainage when they are long-standing. The treatment of choice for direct fistulas is by detachable balloon, which has been shown to be superior to other techniques.

[Preoperative embolization in meningioma of the ponto-cerebellar angle. Indications and advantages]. / Embolización preoperatoria en un meningioma del ángulo ponto-cerebeloso. Indicaciones y ventajas.

Preoperative embolization of meningiomas has been performed in order to reduce surgical hemorrhage during the removal of these vascularized tumors. In this paper we emphasize the fact that occlusion of the tumoral vessels by artificial emboli produces an ischemic necrosis that greatly helps tumor exeresis. This is especially useful in meningiomas of certain localizations requiring complex surgical approaches. In our case, a giant ponto-cerebellar meningioma was dried up totally and then removed with relative ease through a conventional suboccipítal lateral craniectomy. The technique, indications and control of preoperative embolization are reviewed.

Preoperative embolization of solid cervicomedullary junction hemangioblastomas: report of two cases.

Solid cervicomedullary haemangioblastomas represent a small but technically challenging subset of posterior fossa haemangioblastomas because of their site, high vascularity and tendency to bleed. We present our experience with preoperative embolisation of two solid cervicomedullary haemangioblastomas. In both cases the main feeding artery was the posterior inferior cerebellar artery. Arterial pedicles were catheterised with a microcatheter. The embolic material was small particles (150-250 microm) of polyvinyl alcohol. The result was almost complete preoperative obliteration of the vessels of the tumours. The procedure was well tolerated and facilitated easier bloodless, successful resection in both cases, 24 h after embolisation.

Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects, cerebral monitoring, and results.

We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria included xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their aneurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.