Endovascular Treatment of Vertebral Artery Dissecting Aneurysms using Stents.

SUMMARY: We report on five patients who were treated by stent-assisted coil embolization to preserve the patency of the parent artery. Three patients presented with subarachnoid haemorrhage and two with ischemic symptoms. Four patients were treated with stenting and then followed by coil embolization of the aneurysmal dilatation, and the remaining patient with stenting alone because the aneurysmal dilatation was too small to insert coils. Complete obliteration of the aneurysm was achieved in three patients, but in one patient an aneurysmal rupture occurred during the insertion of the first coil and a parent artery occlusion was therefore performed. In the one patient treated with stenting alone, a small aneurysmal dilatation remained patent, but complete obliteration was confirmed by the follow-up angiography. Subsequent subarachnoid haemorrhage was not observed in any of the patients. Four of them achieved a good recovery, but one patient suffered severe disability due to the aneurysmal rupture during the procedure. Parent artery occlusion remains the treatment of choice. Stentassisted coil embolization has a higher risk of rupture than does the parent artery occlusion during the procedure. Furthermore, recanalization or subsequent subarachnoid haemorrhage is more likely to occur in a stent-assisted coil embolization after the procedure. However, this procedure, which can maintain the patency of the parent artery, will become an alternative for patients who are at a high risk of developing ischemic symptoms in parent artery occlusions.

Percutaneous transvenous embolisation through the occluded sinus for transverse-sigmoid dural arteriovenous fistulas with sinus occlusion.

We report six cases of transverse-sigmoid dural arteriovenous fistulae (TS DAVF) treated with percutaneous transvenous embolisation through the occluded sinus. All patients had sinus occlusive lesions: an isolated sinus in five cases and a distal occlusion of the affected sinus in one. Leptomeningeal retrograde venous drainage via the vein of Labbé or the sylvian vein was observed in all patients with an isolated sinus. In five patients a microcatheter was easily passed through the occluded sinus. In four of them, a complete angiographic cure was achieved by packing the sinus with coils. However, in one, sinus packing was ineffective and surgical excision of the affected sinus was necessary. The microcatheter could not be passed through the occluded sinus in one case, and direct packing of the isolated sinus was later required. In all cases, complete cure was achieved without complications. This safe, not very invasive and highly effective treatment for TS DAVF with sinus occlusion is thus worth trying when the occluded segment is relatively short.

Angiographic findings and clinical significance of the anterior and posterior spinal arteries in therapeutic parent artery occlusion for vertebral artery aneurysms.

SUMMARY: Three of 16 patients with vertebral artery (VA) aneurysms treated by parent artery occlusion suffered ischemic complications. The cause of the ischemic complications was brain stem or upper cervical spinal cord infarction due to occlusion of the anterior spinal artery (ASA), posterior spinal artery (PSA) and perforating arteries arising from the VA. Angiographic detection of ASA and PSA was studied in 71 consecutive patients (142 VAs) with various diseases who underwent digital subtraction angiography. The ASA and PSA originated from the bilateral VAs in 14% and 9%, unilateral VA in 73% and 35%, and were not detected in 13% and 56%, respectively. These results indicate that the rate of angiographic detection of the ASA originating from the bilateral VAs is considerably lower than that of previously reported anatomical studies. Special attention must be paid to the ASA, PSA and perforating arteries on preoperative vertebral angiography to prevent ischemic complications associated with therapeutic parent artery occlusion for VA aneurysms.

[Problems of early diagnosis of pancreatic cancer and evaluation of various morphological studies].

Clinical symptoms and abnormality of laboratory examinations in 62 patients with proven pancreatic carcinoma were studied. The following indications for detailed examination of the pancreas have been evolved: (1) vague abdominal symptoms, (2) jaundice, (3) abnormalities of laporatory examinations including serum LAP, ALP, amylase and cholinesterase level, and abnormal GTT. In the jaundiced patient the initial examination is US followed by PTCD to relieve the jaundice, and then angiography to assess resectability of the tumor. In the non-jaundiced patient US is used as a screening procedure. Should this be abnormal a lesion may be confirmed by CT. If not ERCP is indicated when there is some distinct reason to suspect pancreatic disease. If ERCP reveals abnormality then angiography is performed to determine whether the lesion is benign or malignant, and if malignant it is resectable or not. In the period of 1968 and 1981, 112 proven pancreatic carcinomas were studied. Overall resectability was 26%. Thirty tumors were less than 3 cm and the smallest lesion measured 1.2 cm.