In recent two years, new reports about concepts, technologies, materials, and especially new clinical trial results for endovascular treatment of cerebrovascular diseases, has provided tremendous promise for further progress. Mechanical thrombectomy becomes a guideline-recommended therapy for acute ischemic stroke patients with large vessel occlusion, which is considered as a landmark event. The superiority of endovascular coiling over neurosurgical clipping has been further proved for intracranial aneurysm. New devices are constantly developing for aneurysm occlusion. For brain arteriovenous malformation, application of detachable-tip microcatheters improves safety of embolization procedure, and successful transvenous embolization has been also achieved in a few cases. Long-term result of carotid stenting for symptomatic patients has been proved to be noninferior to carotid endarterectomy. Meanwhile, some new trials only obtain negative results, for example, endovascular stenting for intracranial or vertebral artery stenosis both show worse outcomes compared with medical therapy alone. More advancements and investigations are needed.
Embolization, Therapeutic ; instrumentation ; Endarterectomy, Carotid ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents ; Stroke ; therapy ; Thrombectomy ; Vertebrobasilar Insufficiency ; therapy

OBJECTIVE: The aim of this study was to determine the interobserver and intermodality agreement in the interpretation of time-of-flight (TOF) MR angiography (MRA) for the follow-up of coiled intracranial aneurysms with the Enterprise stent. MATERIALS AND METHODS: Two experienced neurointerventionists independently reviewed the follow-up MRA studies of 40 consecutive patients with 44 coiled aneurysms. All aneurysms were treated with assistance from the Enterprise stent and the radiologic follow-up intervals were greater than 6 months after the endovascular therapy. Digital subtraction angiography (DSA) served as the reference standard. The degree of aneurysm occlusion was determined by an evaluation of the maximal intensity projection (MIP) and source images (SI) of the TOF MRA. The capability of the TOF MRA to depict the residual flow within the coiled aneurysms and the stented parent arteries was compared with that of the DSA. RESULTS: DSA showed stable occlusions in 25 aneurysms, minor recanalization in 8, and major recanalization in 11. Comparisons between the TOF MRA and conventional angiography showed that the MIP plus SI had almost perfect agreement (kappa = 0.892, range 0.767 to 1.000) and had better agreement than with the MIP images only (kappa = 0.598, range 0.370 to 0.826). In-stent stenosis of more than 33% was observed in 5 cases. Both MIP and SI of the MRA showed poor depiction of in-stent stenosis compared with the DSA. CONCLUSION: TOF MRA seemed to be reliable in screening for aneurysm recurrence after coil embolization with Enterprise stent assistance, especially in the evaluation of the SI, in addition to MIP images in the TOF MRA.
Angiography, Digital Subtraction/methods ; Cerebral Angiography/methods ; Embolization, Therapeutic/instrumentation/*methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/diagnosis/radiography/*therapy ; Magnetic Resonance Angiography/*methods ; Male ; Middle Aged ; Observer Variation ; Recurrence ; Reference Standards ; *Stents

OBJECTIVE: Tiny cerebral aneurysms are difficult to embolize because the aneurysm's sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms. MATERIALS AND METHODS: Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up. RESULTS: All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela. CONCLUSION: The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data.
Adult ; Aged ; Cerebral Angiography ; Embolization, Therapeutic/*instrumentation ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/pathology/*therapy ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Stents ; Treatment Outcome

OBJECTIVE: A small branch-incorporated aneurysm is an aneurysm with a small branch incorporated into the sac or the neck. It is one of the most difficult aneurysms to treat with coil embolization. The aim of this study was to evaluate the safety and effectiveness of the coil-protected embolization technique for small-branch incorporated aneurysm. MATERIALS AND METHODS: Fourteen aneurysms (2 ruptured and 12 unruptured) in 12 patients (mean age, 56 years, range, 40-73 years; 6 men and 6 women) were treated with the coil-protected embolization technique during the period between February 2007 and October 2011. Clinical and angiographic outcomes were retrospectively evaluated. RESULTS: All aneurysms were successfully treated without any complications during the procedure. Immediate post-treatment angiographies demonstrated complete or near complete occlusion in 12 and incomplete occlusion in 2 patients. Two patients had a delayed small embolic infarction in the relevant posterior circulation territory and middle cerebral artery territory 10 days and 14 days later, respectively, but both recovered completely or almost completely (modified Rankin scale score [mRS score], 0 and 1, respectively). During the clinical follow-up period (mean, 21 months; range: 2-58 months), all patients reported an mRS score of 0 (n = 10) or 1 (n = 2). Vascular imaging follow-up (catheter angiography: n = 3 and MR angiography: n = 8) was available in 11 aneurysms at 6-12 months. All 11 aneurysms showed complete occlusion except for 1 minor neck recurrence that did not require further treatment. CONCLUSION: In this series of cases, the coil-protected embolization technique seems to be feasible and effective in the treatment of small-branch incorporated aneurysms.
Adult ; Aged ; Aneurysm, Ruptured/diagnosis/*therapy ; Embolization, Therapeutic/instrumentation/*methods ; Female ; Humans ; Intracranial Aneurysm/diagnosis/*therapy ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Several substances have been used in an attempt to sclerose biliary ducts associated with persistent biliary-cutaneous fistula (BCF). The AMPLATZER Vascular Plug (AVP; AGA Medical, USA) system is a recently developed endovascular occlusion device, introduced as an alternative to permanent embolic materials (metallic coils or acrylic glue), in the occlusion of large and medium-calibre arteries and veins. We report a successful use of the AVP to embolize BCF, developed after the removal of an internal-external biliary drainage.
Aged ; Biliary Fistula/radiography/*therapy ; Cholangiography ; Cutaneous Fistula/radiography/*therapy ; Embolization, Therapeutic/*instrumentation ; Female ; Humans ; *Septal Occluder Device

OBJECTIVETo evaluate the efficacy and safety of Solitaire(TM) AB neurovascular stenting-assisted coil embolization for patients with wide-necked or dissecting aneurysms.

METHODSThe clinical results and prognosis from a consecutive series of 38 patients with 40 wide-necked or dissecting aneurysms aneurysms who treated by Solitaire(TM) AB neurovascular stenting-assisted coil embolization from August 2010 to January 2012 was retrospectively analyzed. There were 12 male and 26 female patients, the age was 21 - 78 years (mean 55 years). Thirty-one cases were confirmed wide-neck aneurysms and 9 cases were dissection aneurysms by DSA. Acute subarachnoed hemorrhage due to the rupture of aneurysms was seen in 28 cases (according Hunt-Hess scale, 1 case of Class I, 20 cases of Class II, 4 cases of Class III, 3 cases of Class IV), 1 case was traumatic intracranial aneurysm, 1 case was misdiagnosed during the operation of pituitary adenoma by the approach of transsphenoid, and unruptured aneurysms were seen in 8 cases. The aneurysms were located at the posterior communicating segment of internal carotid artery (21 cases), the supraclinoid segment of internal carotid artery (6 cases), the cavernous segment of internal carotid artery (3 cases), the anterior communicating artery (1 case), and the vertebral artery (9 cases). The patients were performed DSA and Glasgow outcome score (GOS) to evaluate the prognosis 6 months after surgery.

RESULTSForty stents were used and all remodeling device were achieved successful position. Owing to acute thrombosis in 3 patients, the stents were retrieved successfully. The proportion of patients in whom Raymond class 1 occlusion was obtained in 31 cases (77.5%), Raymond class 2 occlusion in 5 cases (12.5%) and Raymond class 3 occlusion in 4 cases (10.0%). The follow-up was 3 to 12 months (median 6 months). The results of DSA indicated none of the patients' anuerysm was recurred; and GOS was applied to evaluate the prognosis of patients after 3 months. Of 38 patients, 34 recovered well, 3 moderately disabled, 1 patient died.

CONCLUSIONSIt is safe to embolize aneurysms with Solitaire(TM) AB neurovascular stenting-assisted coil; meanwhile, the stents can be retrieved when acute thrombosis to reduce the complications.

Adult ; Aged ; Aneurysm, Dissecting ; therapy ; Cerebral Angiography ; Embolization, Therapeutic ; instrumentation ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Young Adult

Lower gastrointestinal haemorrhage due to enteric fever is uncommon and potentially fatal. The majority of patients recover with conservative treatment, with surgery reserved for life-threatening bleeding. Given the advances in radiologically guided procedures, there have been numerous reports of successful embolisation for gastrointestinal haemorrhage, although few of these involved enteric fever as the causative agent. We report an uncommon case of haemorrhagic enteric fever treated successfully with embolisation using polyvinyl alcohol particles and coils.
Adult ; Angiography ; Embolization, Therapeutic ; instrumentation ; methods ; Female ; Gastrointestinal Hemorrhage ; therapy ; Humans ; Polyvinyl Alcohol ; chemistry ; Tomography, X-Ray Computed ; Treatment Outcome ; Typhoid Fever ; therapy

Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.
Cerebellar Diseases/radiography/*therapy ; Cerebral Angiography ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Intracranial Aneurysm/radiography/*therapy ; Male ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

OBJECTIVE: Device- or technique-related air embolism is a drawback of various neuro-endovascular procedures. Detachable aneurysm embolization coils can be sources of such air bubbles. We therefore assessed the formation of air bubbles during in vitro delivery of various detachable coils. MATERIALS AND METHODS: A closed circuit simulating a typical endovascular coiling procedure was primed with saline solution degassed by a sonification device. Thirty commercially available detachable coils (7 Axium, 4 GDCs, 5 MicroPlex, 7 Target, and 7 Trufill coils) were tested by using the standard coil flushing and delivery techniques suggested by each manufacturer. The emergence of any air bubbles was monitored with a digital microscope and the images were captured to measure total volumes of air bubbles during coil insertion and detachment and after coil pusher removal. RESULTS: Air bubbles were seen during insertion or removal of 23 of 30 coils (76.7%), with volumes ranging from 0 to 23.42 mm3 (median: 0.16 mm3). Air bubbles were observed most frequently after removal of the coil pusher. Significantly larger amounts of air bubbles were observed in Target coils. CONCLUSION: Variable volumes of air bubbles are observed while delivering detachable embolization coils, particularly after removal of the coil pusher and especially with Target coils.
Embolism, Air/*etiology ; Embolization, Therapeutic/*adverse effects/*instrumentation ; Intracranial Embolism/*etiology ; Magnetic Resonance Imaging/methods ; Microscopy ; Risk Assessment ; Statistics, Nonparametric

Pulmonary arteriovenous malformations (PAVMs) are often treated by pushable fibered or non-fibered microcoils, using an anchor or scaffold technique or with an Amplatzer plug through a guiding sheath. When performing percutaneous transcatheter microcoil embolization, there is a risk of coil migration, particularly with high-flow type PAVMs. The authors report on a unique treatment in a patient with a giant high-flow PAVM whose nidus had a maximum diameter of 6 cm. A detachable coil, not detached from a delivery wire (an anchored detachable coil), was first placed in the feeding artery under flow control by balloon occlusion, and then multiple microcoils were packed proximally to the anchored detachable coil. After confirming the stability of the microcoils during a gradual deflation of the balloon, we finally released the first detachable coil. The nidus was reduced in size to 15 mm at one year postoperatively.
Arteriovenous Malformations/*therapy ; Balloon Occlusion/*methods ; Catheterization ; Contrast Media/diagnostic use ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Artery/*abnormalities ; Pulmonary Veins/*abnormalities ; Tomography, X-Ray Computed