The Rationale Behind Transcirculation Neuroendovascular Interventions: Literature Review Through a Case-Series Approach.

BACKGROUND: With the development of advanced endovascular techniques and materials, neurointerventionalists can perform challenging and complex cases that were previously difficult to perform. Transcirculation approaches could be a useful tool used in complicated cases, providing access to the target vessel, through the contralateral or opposite circulation, when anterograde access is difficult or nonachievable. OBJECTIVE: To retrospectively review cerebrovascular interventions performed through a transcirculation approach performed by staff at our Institution. METHODS: English-language studies, published until August 2022, reporting transcirculation interventions in the cerebrovascular circulation were retrospectively collected. Type of intervention, number of cases, rationale, and complications were analyzed. Furthermore, similar cases performed by staff currently at our institution were also reviewed and described. RESULTS: Including our cases, a total of 273 transcirculation treatment approaches have been reported. Intracranial aneurysm embolization, stroke thrombectomies, intra-arterial ophthalmic chemotherapy, arteriovenous malformationss, arteriovenous fistulas embolizations, and intracranial angioplasty and stenting are common indications. Reason for using a retrograde approach were stent/balloon-assisted coiling of wide neck aneurysm in 116 cases, difficult angulation of branch in 91 cases, occlusion of parent vessel in 55 cases, and bailout/other in 11 cases. CONCLUSION: Transcirculation approaches can be considered for cases where conventional anterograde treatment options are not feasible or as a bailout strategy in failed or complicated treatment attempts. They represent a strategy to consider when facing challenging cases, and if performed by experienced and dedicated neurointerventionalists, they can represent a safe alternative.

Coexistence of superior mesenteric artery syndrome and nutcracker phenomenon.

Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Nutcracker syndrome occurs as the result of external compression of the left renal vein. Although they share a similar pathophysiology, SMA and nutcracker syndrome occurring simultaneously is rare. In this case report, we discuss the pathophysiology and unique computed tomography findings in a 25-year-old female patient diagnosed with SMA syndrome who was also incidentally found to have a coexisting nutcracker phenomenon. Due to similar pathogenesis, radiologists should consider the possibility of coexistence of these rare syndromes in appropriate patients.

"Target sign" from dropped gallstones after laparoscopic cholecystectomy.

Isolated case reports and small series in radiologic and surgical literature relay the different modes of clinical presentation that arise secondary to spillage of gallstones during surgery. We report a case of a 70-year-old female who presented with a 2-week history of right-sided abdominal pain. CT (computerized tomography) imaging findings demonstrated multiple peripherally enhancing hypoattenuating lesions in the right subphrenic space abutting the hepatic dome, concerning for abscesses. The lesions were found to have a characteristic central hyperattenuating focus (Target Sign) consistent with gallstones, as identified on a pre-cholecystectomy CT, resulting in the early diagnosis and treatment of dropped gallstones from prior laparoscopic cholecystectomy approximately 1 year prior to presentation.