Stent assisted coiling (SAC) is a useful technique for the treatment of wide necked complex aneurysm. As the frequency of SAC increases, stent-related complications such as thromboembolism, aneurysm rupture, and vessel rupture have been reported. However, to the best of our knowledge, carotid-cavernous fistula (CCF) after SAC has never been reported. The authors experienced a case of direct CCF after a SAC procedure for treatment of a complex posterior communicating artery (PCoA) aneurysm regrowth, which was treated by clip ligation 12 years before. The patient was managed conservatively and angiograms performed three months after the procedure showed the complete obliteration of the left PcoA aneurysm and the spontaneous disappearance of CCF. Navigation of Solitaire stent lumen with microcatheter can cause unexpected arterial injury, especially when the proximal tip is placed in the curved portion. It seems to be desirable to place the proximal tip of Solitaire stent in the straight portion whenever possible to reduce the risk of inadvertent arterial injury which might be caused by future navigation of stent lumen.
Aneurysm ; Arteries ; Embolization, Therapeutic* ; Fistula* ; Humans ; Iatrogenic Disease ; Intracranial Aneurysm* ; Ligation ; Neck ; Rupture ; Stents* ; Thromboembolism

Radiation-induced vasculopathy is a rare occurrence, however, it is one of the most serious complications that can occur after gamma-knife radiosurgery (GKRS). The authors present two cases of incidentally found deep cerebral arteriovenous malformation (AVM), which were treated by GKRS, where subsequently there occurred delayed-onset cerebral infarction (11 and 17 months after GKRS) at an area adjacent to the AVM. In both cases, perforators of the M1 segment of the middle cerebral artery were included in the radiation field and delayed injury to these is suggested to be the mechanism of the ischemic event.
Arteries* ; Arteriovenous Malformations* ; Cerebral Infarction ; Intracranial Arteriovenous Malformations ; Middle Cerebral Artery ; Radiosurgery* ; Stroke*

Cavernous malformations (CMs), characterized by the presence of a hemosiderin rim and intralesional hemorrhage, are relatively common intracranial vascular malformations. Extralesional hemorrhages arising from CMs are seen in a minority of cases, but most of them show typical CM findings on magnetic resonance imaging. Here, the authors report two cases of pathologically confirmed CM presenting with unusual and large intracerebral hemorrhages, which were not surrounded by the typical hemosiderin rim. CMs presenting with large intracerebral hemorrhage should be considered in the differential diagnosis of massive intracerebral hemorrhages.
Cerebral Hemorrhage* ; Diagnosis, Differential ; Hemorrhage ; Hemosiderin ; Magnetic Resonance Imaging ; Vascular Malformations

Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.
Arm ; Brachial Artery ; Carotid Artery, Internal ; Catheters ; Constriction, Pathologic* ; Coronary Artery Bypass* ; Endovascular Procedures ; Femoral Artery ; Humans ; Mammary Arteries ; Middle Aged ; Stents* ; Subclavian Artery* ; Subclavian Steal Syndrome* ; Transplants ; Vertebral Artery

Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed a saccular lesion of the upper basilar trunk suggesting a ruptured aneurysm. However, no vascular lesion was observed on immediate subsequent digital subtraction angiography (DSA). In one case, repeated follow up DSA was also negative. The patient was treated conservatively and discharged with no neurologic deficit. In the other case, the patient showed sudden mental deterioration on the third hospital day and her brain CT showed rebleeding. The immediate follow up DSA showed contrast stagnation in the vicinity of the upper basilar artery, suggestive of pseudoaneurysm. Double stent deployment at the disease segment was performed. Due to the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm.
Aneurysm* ; Aneurysm, False ; Aneurysm, Ruptured ; Angiography* ; Angiography, Digital Subtraction ; Basilar Artery* ; Brain ; Extravasation of Diagnostic and Therapeutic Materials ; Follow-Up Studies ; Humans ; Neurologic Manifestations ; Stents ; Subarachnoid Hemorrhage* ; Vascular Diseases

OBJECTIVE: During mechanical thrombolysis, to reduce procedure-related complications and time, the authors have performed a simple suction thrombectomy technique. In this article, the authors describe the technical details and clinical outcomes of this technique. MATERIALS AND METHODS: From January 2013 to December 2013, 14 consecutive acute ischemic stroke (AIS) patients with large cerebral arterial occlusions in the middle cerebral artery (MCA; n = 7), internal cerebral artery (ICA; n = 5), basilar artery (BA; n = 1), and a tandem lesion (ICA and MCA; n = 1) were treated using this technique. The proximal part of the occluding clot was aspirated or captured and retrieved as one piece using a large bored microcatheter by applying negative suction pressure using a 50 mL syringe. RESULTS: Overall recanalization rate was 85.7% (12 patients). In the 8 patients in whom this technique was used alone, the recanalization rate was 87.5% (7 patients). The median procedural duration was 30 minutes (range 17-112) in these 7 patients. Distal embolism did not occur. Two patients developed post-procedural intracerebral hemorrhages and one was symptomatic. His modified Rankin Scale (mRS) score at 90 days was 4. CONCLUSION: This technique is a feasible, fast, and safe method for treatment of AIS.
Basilar Artery ; Cerebral Arteries ; Cerebral Hemorrhage ; Embolism ; Humans ; Mechanical Thrombolysis ; Middle Cerebral Artery ; Stroke ; Suction* ; Syringes ; Thrombectomy*

OBJECTIVE: The authors evaluated the feasibility and targeting accuracy of CT fluoroscopy (CTF)-guided catheter placement and aspiration of intracerebral hematoma (ICH)s. MATERIALS AND METHODS: Nine patients (mean age, 63.3 +/- 15.3 years) were treated by CTF-guided hematoma aspiration under local anesthesia. The targeting errors in the lesion center, volume of the aspirated hematoma, accuracy of the final catheter position, procedure time, and clinical outcomes were evaluated. RESULTS: All catheters were successfully placed in the center of the hematoma. The mean volume of the aspirated hematoma was 20.6 +/- 8.8 mL (pre-treatment, 44.7 +/- 20.1 mL; post-treatment, 24.1 +/- 13.8 mL). The average procedure time was 25.1 minutes (range, 18-32 minutes). In one case with a scanty residual hematoma, the catheter was removed at the end of the procedure. In the remaining eight cases, the catheter was left in the residual hematoma for drainage and all catheter tips were accurately located in the final position. There were no procedure-related complications, including rebleeding and infection. CONCLUSION: CTF-guided ICH aspiration is a feasible, quick, and accurate procedure which could substitute for stereotactic methods. The accurate catheter position provided by real-time observation enables an effective aspiration and drainage of hematomas.
Anesthesia, Local ; Catheters ; Cerebral Hemorrhage ; Drainage ; Fluoroscopy ; Hematoma* ; Humans

Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.
Aneurysm* ; Basilar Artery* ; Embolization, Therapeutic ; Stents*

There are a number of complications associated with ventriculoperitoneal shunt (VPS) surgery. The authors present a rare case of iatrogenic common carotid artery injury during VPS surgery.
Carotid Artery, Common* ; Ventriculoperitoneal Shunt*

Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.
Adult ; Athletes ; Carotid Arteries ; Carotid Artery Injuries ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Diagnostic Errors ; Education ; Humans ; Martial Arts ; Neurologic Manifestations ; Organization and Administration ; Sports ; Stents ; Stroke ; Vascular System Injuries