PURPOSE: Alcohol is not used directly to the vascular lesion without mixing with the contrast agent because alcohol itself cannot be seen on the fluoroscopy. Since we have used alcohol for the venous malformations in the head and neck area, we realized that alcohol can be safely and effectively used without using fluoroscopy. We present the method of direct sclerotherapy using absolute alcohol without using fluoroscopy. MATERIALS AND METHODS: After obtaining and carefully analyzing direct puncture venogram, we used this technique in 22 patients who underwent alcohol sclerotherapy. Because fluoroscopy was not used during alcohol injection, the angiotable can be placed outside of C-arm so that alcohol was comfortably injected without any obstacle around the patients. Venogram can also be obtained between the injections to detect whether there is any dangerous venous outflow drainage such as the superior ophthalmic vein to the cavernous sinus. To control the venous outflow, local compression to the draining vein was applied. The result and complication such as skin necrosis, infection, and nerve injury were evaluated during mean follow-up period of 13 months (range, 1-63 months). RESULTS: The frequency of sclerotherapy was one in 16 and 2-5 in 6 patients. The volume of alcohol used per treatment session ranged from 2 to 18 mL (mean, 8.5 mL). There was the minimum change in 1 (4.5%), moderately decreased lesion in 12 (54.5%), and markedly decreased lesion in 9 (41%) patients. The patients did not reveal any complications during 12.9 months follow-up period. CONCLUSION: Direct puncture alcohol sclerotherapy without using fluoroscopy can be a safe and effective technique for treating venous malformation of the head and neck areas. In addition, the procedure can be performed in the comfortable position because biplane fluoroscopy would not be necessary.
Cavernous Sinus ; Drainage ; Endovascular Procedures ; Ethanol ; Fluoroscopy ; Follow-Up Studies ; Head ; Humans ; Neck ; Necrosis ; Punctures ; Sclerotherapy ; Skin ; Vascular Malformations ; Veins

PURPOSE: Cerebral arterial dissections are recognized as a common cause of stroke. However, few studies have reported on the distribution of cerebral arterial dissection and angiographic pattern related to the presenting clinical symptom pattern. We analyzed the distribution of cerebral artery dissection along with angiographic and clinical presenting a pattern as depicted on angiograms. MATERIALS AND METHODS: From January 2000 to January 2007, 133 arterial dissection patients admitted to our institutes were retrospectively reviewed. The characteristic angiographic findings of all cerebral arteries were carefully evaluated on 4-vessel angiograms. The male-female ratio was 77: 56 and the mean age was 51 years. According to the angiographic finding depicting the location of the dissection plane in the arterial wall, we categorized to steno-occlusive, aneurysmal, combined and unclassifiable pattern. In each dissection pattern, we evaluated presenting symptoms and presence of infarction or hemorrhage. RESULTS: The most common symptom on presentation was headache (47%), followed by motor weakness of arm or leg (31%), dysarthria/aphasia (19%) and vertigo (16%). The most common angiographic pattern was steno-occlusive (46%), followed by combined (steno-occlusive and aneurismal) (27%) and aneurysmal (22%) patterns. Steno-occlusive pattern was most commonly related to infarction (33/61, 54%) in contrast that aneurysmal pattern was most frequently related to subarachnoid hemorrhage (SAH) (7/29, 24%). The most frequent abnormality in patients with dissection of the intradural vertebral arteries including posterior cerebral artery (PCA) was SAH (23/70, 33%), followed by infarction. Infarction was the most common abnormality in patients with the extradural and intradural carotid arteries, and the extradural vertebral artery. CONCLUSION: In contrast that the extradural arterial dissections tended to result in ischemia with steno-occlusive pattern, the intradural arterial dissections tended to result in SAH with aneurysmal type, especially in the vertebral artery. Dissection requires combined analysis of angiographic pattern and type of stroke depending on the location.
Academies and Institutes ; Aneurysm ; Arm ; Carotid Arteries ; Cerebral Arteries ; Headache ; Humans ; Infarction ; Ischemia ; Leg ; Posterior Cerebral Artery ; Retrospective Studies ; Stroke ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vertigo

PURPOSE: The in-stent signal reduction of the stented artery caused by susceptibility artifact or radiofrequency shielding artifact limited the use of time-of-flight MR angiography (TOF-MRA) as a follow-up tool after intracranial stenting. We showed the degree of an artifact according to different stent types, and optimized MR parameters for TOF-MRA in patients with intracranial stent on 3.0 T MRI. MATERIALS AND METHODS: Four stents (Neuroform, Wingspan, Solitaire, and Enterprise) were placed in a vascular flow phantom and imaged by changing flip angle (FA; 20degrees,30degrees,40degrees,50degrees and 60degrees) and bandwidth (BW; 31, 42 and 62.5 KHz) using TOF-MRA. Source data of each image set with different FA and BW were reconstructed with the maximal intensity projection (MIP) technique, and MIP images were used to evaluate the in-stent signal reduction of each stent according to the change of MR parameters. The in-stent signal reduction was assessed by calculating the relative in-stent signal (RIS) inside the stent as compared with background and signal intensity of the tube outside the stent. The optimal FA and BW of each stent were determined by comparing the RIS in each stent by one-sample t test. Finally, one neuroradiologist chose one image set with the best image quality. RESULTS: The mean RIS for Neuroform, Wingspan, Solitaire and Enterprise stent was 66.3 +/- 6.0, 44.2 +/- 5.8, 22.8 +/- 3.3 and 8.2 +/- 2.9, respectively. The significantly high RIS of each stent was obtained with FA/BW value of 20degrees/31 KHz (Neuroform), 20degrees/31 KHz and 30degrees/42 KHz (Wingspan), 40degrees/42 KHz and 50degrees/31 KHz (Solitaire) and 40degrees/31 KHz and 50degrees/31 KHz (Enterprise). Among these MIP images with significantly high RIS, images with FA/BW value of 20degrees/31 KHz (Neuroform and Wingspan) and 50degrees/31 KHz (Solitaire and Enterprise) had the best image quality. CONCLUSION: The degree of artifact was variable according to the design of each intracranial stent. The luminal visualization of closed-cell design stents such as Solitaire and Enterprise can be improved by higher FA. Thus, MR parameter should be adjusted according to the type of intracranial stents.
Angiography ; Arteries ; Artifacts ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Phenobarbital ; Stents

Rapid and striking development in both the techniques and devices make it possible to treat most of cerebral aneurysms endovascularly. Stent has become one of the most important tools in treating difficult aneurysms not feasible for simple coiling. The physical features, the dimensions, and the functional characteristics of the stents show considerable differences. There are also several strategies and tips to treat difficult aneurysms by using stent and coiling. Nevertheless, they require much experience in clinical practice as well as knowledge of the stents to treat cerebral aneurysms safely and effectively. In this report, a brief review of properties of the currently available stents and strategies of their application is presented.
Aneurysm ; Endovascular Procedures ; Intracranial Aneurysm ; Stents ; Strikes, Employee

No abstract available.
Stem Cells

No abstract available.

We present a 61-year-old female with an unruptured intracranial aneurysm on the left superior hypophyseal artery. The patient was treated with endovascular management, stent-assisted coil embolization. Multiple embolic infarction and total occlusion of the left internal carotid artery (ICA) was occurred one day later. At 14 days of heparinization, complete recanalization of the ICA and full recovery of neurologic symptoms were achieved. Stent-assisted coil embolization is not without risk of instent thrombosis and the subsequent embolism. The cause of subacute in-stent thrombosis and natural course were uncertain; however, the clinical course may potentially be fatal. Therefore, rapid diagnosis and proper treatment are recommended.
Arteries ; Carotid Artery, Internal ; Embolism ; Female ; Heparin ; Humans ; Infarction ; Intracranial Aneurysm ; Middle Aged ; Neurologic Manifestations ; Thrombosis

Neurofibromatosis type 1 (NF-1) has a variety of localized or systemic manifestations. Among them, Cerebrovascular dysplasia can be very rare finding of neurofibromatosis which can be very rarely seen. Here we report a case of 17-year-old boy representing bilateral giant fusiform aneurysms of extracranial internal carotid arteries and intracranial aneurysms of left middle cerebral artery. He showed no related symptoms at all, but screening for vascular lesions and close monitoring is warranted in NF-1 patients considering that it can be symptomatic unexpectedly.
Adolescent ; Aneurysm ; Carotid Artery, Internal ; Humans ; Intracranial Aneurysm ; Mass Screening ; Middle Cerebral Artery ; Neurofibromatoses ; Neurofibromatosis 1

Herniation of coil loops into the parent artery is one of the complications of endovascular embolization with detachable coils. In this clinical setting, we cannot predict the consequence of the herniated coil loop. We report an unusual case of a superior cerebellar artery (SCA) aneurysm with delayed coil herniation into the basilar artery and spontaneous reposition into the SCA.
Aneurysm ; Arteries ; Basilar Artery ; Humans ; Intracranial Aneurysm ; Parents

We experienced rare combination of multiple irregular shaped aneurysms along the course of the feeding artery and arteriovenous malformation (AVM) in the posterior circulation. We could not explain which aneurysm was a cause of bleeding because all the aneurysms showed irregular in shape like pseudoaneurysms and location of the aneurysms was very close each other. We report two cases in which multiple irregular shaped aneurysms were related with AVMs and first episode of hemorrhage.
Aneurysm ; Aneurysm, False ; Arteries ; Arteriovenous Malformations ; Hemorrhage