Journal of neurointerventional surgery
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The use of balloon remodeling allows for the treatment of aneurysms that were previously considered to be poor candidates for coil embolization. The Scepter C (Microvention, Tustin, California, USA) is a novel temporary occlusion balloon system with a dual coaxial lumen catheter. The design accommodates a more steerable 0.014 inch guidewire with improved control for delivery to the target lesion. We describe our initial experience with the use of this device for balloon remodeling to assist during aneurysm coil embolization. ⋯ Our initial experience with the dual coaxial lumen Scepter C occlusion balloon catheter demonstrates its feasibility for use in balloon remodeling for aneurysm coil embolization. A variety of aneurysms at different locations were treated with satisfactory initial angiographic results and adverse event rates.
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There is wide variability in the reported incidence of perioperative thromboembolic (0-14%) and hemorrhagic (0-11%) complications after Pipeline Embolization Device (PED) procedures for cerebral aneurysm treatment, which could be partly due to differences in patient response to the P2Y12 receptor antagonist administered while the PED endothelializes. This study aims to identify an optimal pre-procedure P2Y12 reaction units (PRU) value range and determine the independent predictors of perioperative thromboembolic and hemorrhagic complications after PED procedures. ⋯ In our cohort, a pre-procedure PRU value of <60 or >240 was the strongest independent predictor of all and major perioperative thromboembolic and hemorrhagic complications after PED procedures.
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Inflammation as a predictor for delayed cerebral ischemia after aneurysmal subarachnoid haemorrhage.
The mechanism of development of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is poorly understood. Inflammatory processes are implicated in the development of ischemic stroke and may also predispose to the development of DCI following SAH. The objective of this study was to test whether concentrations of circulating inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin 1 receptor antagonist (IL-1Ra)) were predictive for DCI following SAH. Secondary analyses considered white cell count (WCC) and erythrocyte sedimentation rate (ESR). ⋯ Leucocytosis and change in IL-6 prior to DCI reflect impending cerebral ischemia. The time-independent association of ESR with DCI after SAH may identify this as a risk factor. These data suggest that systemic inflammatory mechanisms may increase the susceptibility to the development of DCI after SAH.
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In this case report we describe a successful interdisciplinary approach (including flow redirection and endovascular occlusion) applied to a patient with a continuously growing extracranial giant aneurysm of the right internal carotid artery (ICA) due to known Ehlers-Danlos syndrome. ⋯ This case report describes a successful interdisciplinary approach for the treatment of a rare giant extracranial ICA aneurysm in a patient with Ehlers-Danlos syndrome. Treatment options for this type are few and carry high risks. Flow redirection via extracranial-intracranial bypass followed by endovascular occlusion appears to be a good treatment approach.
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Case Reports
Occlusion of a clival dural arteriovenous fistula using a novel approach through the foramen ovale.
Dural arteriovenous fistulas (DAVFs) are abnormal connections between arteries and veins that are classified by location, morphology or direction of venous drainage. Treatment of DAVFs is undertaken in patients with severe symptoms or those with retrograde cortical venous drainage and/or venous ectasia. ⋯ Specialised software was used to create a safe trajectory to the DAVF via the foramen ovale. The patient then underwent successful occlusion of the clival DAVF, thus further increasing the neurointerventionalist's armamentarium when attempting to treat difficult to reach clival DAVFs.