Giant internal carotid artery (ICA) aneurysms are complex vascular lesions which are difficult to treat with open as well as endovascular surgery. Parent vessel occlusion is a well-established treatment option for such aneurysms. However, there have been a few reported cases of ruptured aneurysms related to the persistent retrograde filling after parent vessel occlusion. We report a case which highlights the usage of the flow diverter stent as a potential treatment strategy for the management of retrograde filling of aneurysms. A 54-year-old female was found to have a giant left ICA aneurysm on a brain magnetic resonance imaging during workup for headaches. She underwent occlusion of the left ICA proximal to the aneurysm using multiple coils. However, follow up angiograms after 6 months and 2 years demonstrated persistent retrograde filling of the left ICA aneurysm through the posterior communicating (PCOM) artery. Eventually, she was successfully treated with a flow diverter stent across the PCOM artery into the distal ICA. Follow up angiogram after 6 months showed patent flow in the PCOM artery and the distal ICA. with complete occlusion of the aneurysm. Using a flow diverter stent after insufficient parent vessel occlusion for giant intracranial aneurysms may be a feasible treatment option and an addition to the neurovascular treatment armamentarium.

Giant internal carotid artery (ICA) aneurysms are complex vascular lesions which are difficult to treat with open as well as endovascular surgery. Parent vessel occlusion is a well-established treatment option for such aneurysms. However, there have been a few reported cases of ruptured aneurysms related to the persistent retrograde filling after parent vessel occlusion. We report a case which highlights the usage of the flow diverter stent as a potential treatment strategy for the management of retrograde filling of aneurysms. A 54-year-old female was found to have a giant left ICA aneurysm on a brain magnetic resonance imaging during workup for headaches. She underwent occlusion of the left ICA proximal to the aneurysm using multiple coils. However, follow up angiograms after 6 months and 2 years demonstrated persistent retrograde filling of the left ICA aneurysm through the posterior communicating (PCOM) artery. Eventually, she was successfully treated with a flow diverter stent across the PCOM artery into the distal ICA. Follow up angiogram after 6 months showed patent flow in the PCOM artery and the distal ICA. with complete occlusion of the aneurysm. Using a flow diverter stent after insufficient parent vessel occlusion for giant intracranial aneurysms may be a feasible treatment option and an addition to the neurovascular treatment armamentarium.

84 years old gentle man with past medical history of hypertension and diabetes presented with sudden onset right sided weakness and aphasia for two hours. Initial neurological assessment revealed National Institute of Health Stroke Scale (NIHSS) 17. Computed tomography (CT) scan demonstrated minimal early ischemic changes along left insular cortex with occlusion of left middle cerebral artery (MCA). Based on clinical and imaging findings, decision was made to perform mechanical thrombectomy procedure. Initially, right common femoral artery approach was utilized. However, due to unfavorable type-III bovine arch, left internal carotid artery could not be engaged via this approach. Subsequently, access was switched to right radial artery. Angiogram revealed small caliber radial artery, with larger caliber ulnar artery. Attempt was made to advance the guide catheter through the radial artery, however significant vasospasm was encountered. Subsequently, ulnar artery was accessed and successful thrombolysis in cerebral infarction (TICI) III left MCA reperfusion was achieved with a single pass of mechanical thrombectomy via this approach. Post procedure neurological examination demonstrated significant clinical improvement. Doppler ultrasound 48 hours after the procedure demonstrated patent flow in radial and ulnar arteries with no evidence of dissection.

To investigate the prevalence and risk factors of brucellosis in human and animal's communities in southern Saudi Arabia. Methods: A cross-sectional sero-epidemiological study was conducted in Aseer and Jazan, Saudi Arabia (October 2017-October 2018). Human serum samples (n=339) were initially screened for Brucella antibodies and positive samples were further titrated for Brucella antibodies by immunocapture assay (titer of 1:320 as positive). Animal samples (n=828) were screened using the Rose Bengal test. Relationship status was dichotomized to measure and predict independent contributions to variations in human using univariate and multivariate stepwise binary logistic regression model. Results: The rate of brucellosis among the 339 human samples in the two regions was 33.9%, and the rate of acute brucellosis was 12.4%. The rate of brucellosis in animals was 4.7%. Human brucellosis among the target groups was higher in northwestern Aseer (53.3%) compared to Southeastern Aseer (25.9%) and Jazan region (20.6%). The disease was more prevalent among non-Saudi nationals (35.2%) compared to Saudis (30.5%). The rate of brucellosis among butchers and shepherds was 37.5% and 37.2%, respectively. The rate of brucellosis was 37.8% in people over 30 years of age. Our univariate analysis showed that residing in Aseer region (OR: 2.60, 95% CI: 1.50-4.40), especially residing in northwestern Aseer region (OR: 4.40, 95% CI: 2.40-7.90), frequent consumption of raw meat (OR: 2.90, 95% CI: 1.50-5.50), shepherds (OR: 2.10, 95% CI: 0.80-5.30), owning sheep (OR: 2.20, 95% CI: 1.10-4.40), daily contact with animals (OR: 2.10, 95% CI: 0.75-5.80), and those > 30-year-old (OR: 1.50, 95% CI: 1.00-2.40) were significantly associated with increased risks of brucellosis. Our multivariate analysis further showed that residing in northwestern Aseer (OR: 9.16, 95% CI: 3.39-24.76) and having sheep (OR: 1.16, 95% CI: 1.00-1.35) were significant and independent risks of brucellosis while residing in agricultural region (OR: 0.28, 95% CI: 0.10-0.78) was a significant and independent protector against brucellosis. Conclusions: The study concluded that residing in northwestern Aseer area and having animals (sheep) are associated with significantly increased risks of brucellosis.