The treatment of carotid stenosis complicated by severe vessel tortuosity can present challenges in distal vessel selection and device delivery. This article reports the use of a steerable microcatheter (SM) for carotid artery stenting (CAS) in such cases. A 67-year-old male with transient lower extremity weakness and bilateral cerebral infarctions was found to have bilateral carotid stenosis. CAS was planned for both carotid arteries due to coronary artery disease. The left carotid artery exhibited severe stenosis with a 90-degree angle between the common and internal carotid artery (ICA). Anticipating difficulty in navigating the device, we used a 2.4 Fr SM. By adjusting the catheter tip to align with the ICA, we successfully guided the wire distally. Following the catheter exchange, a distal protection device was deployed, and CAS was completed successfully. SMs provide exceptional vascular selectivity and support, improving success in complex cases.

The treatment of carotid stenosis complicated by severe vessel tortuosity can present challenges in distal vessel selection and device delivery. This article reports the use of a steerable microcatheter (SM) for carotid artery stenting (CAS) in such cases. A 67-year-old male with transient lower extremity weakness and bilateral cerebral infarctions was found to have bilateral carotid stenosis. CAS was planned for both carotid arteries due to coronary artery disease. The left carotid artery exhibited severe stenosis with a 90-degree angle between the common and internal carotid artery (ICA). Anticipating difficulty in navigating the device, we used a 2.4 Fr SM. By adjusting the catheter tip to align with the ICA, we successfully guided the wire distally. Following the catheter exchange, a distal protection device was deployed, and CAS was completed successfully. SMs provide exceptional vascular selectivity and support, improving success in complex cases.

Splenic pseudoaneurysm rupture is a serious condition that sometimes leads to death. Pseudoaneurysm rupture is often treated with transcatheter arterial embolization (TAE), after which the re-rupture rate is 18%–37%. A 59-year-old man presented with back pain, and contrast-enhanced computed tomography (CECT) revealed pancreatic tail cancer with multiple liver metastases. After three courses of chemotherapy, CECT revealed good response with shrinkage of the tumors. However, the patient had back pain and CECT revealed pancreatic pseudocyst with pseudoaneurysm rupture. He underwent angiography, wherein the splenic artery pseudoaneurysm was embolized using TAE. Subsequently, pseudocyst drainage was performed using lumen-apposing metal stent (LAMS) to prevent pseudoaneurysm re-rupture. Thereafter, the pseudocyst shrieked with decreased serum levels of C-reactive protein, allowing the patient to re-institute chemotherapy. Pseudocyst drainage using LAMS was safe and effective when the pancreatic pseudoaneurysm had a high-risk rebleeding due to exposure to pancreatic juice.

The treatment of carotid stenosis complicated by severe vessel tortuosity can present challenges in distal vessel selection and device delivery. This article reports the use of a steerable microcatheter (SM) for carotid artery stenting (CAS) in such cases. A 67-year-old male with transient lower extremity weakness and bilateral cerebral infarctions was found to have bilateral carotid stenosis. CAS was planned for both carotid arteries due to coronary artery disease. The left carotid artery exhibited severe stenosis with a 90-degree angle between the common and internal carotid artery (ICA). Anticipating difficulty in navigating the device, we used a 2.4 Fr SM. By adjusting the catheter tip to align with the ICA, we successfully guided the wire distally. Following the catheter exchange, a distal protection device was deployed, and CAS was completed successfully. SMs provide exceptional vascular selectivity and support, improving success in complex cases.

Objective: Almost half of all patients with cancer experience dyspnea, which can have various causes. Although systemic corticosteroids are administered to relieve symptoms, their efficacy has not been established. This systematic review aims to determine the efficacy of systemic corticosteroids for dyspnea in patients with cancer. Methods: CENTRAL, MEDLINE, EMBASE, and Ichushi-Web databases were searched for articles published from their inception to September 23, 2019, on studies of systemic corticosteroid administration for dyspnea in patients with cancer. The primary outcome measure was dyspnea intensity, as assessed by patient-reported outcomes. Secondary outcome measures were quality of life, delirium, and severe adverse events. Results: Two RCTs were included in the meta-analysis. With regard to alleviating dyspnea, the systematic corticosteroid group was associated with significantly greater dyspnea relief than the placebo group (mean difference: −0.71 [95% CI: −1.4 to −0.03]). However, a meta-analysis of quality of life and delirium could not be performed due to insufficient data. Analysis of severe adverse events showed no significant difference in their incidence between the corticosteroid and control groups (relative rate: 0.96 [95% CI: 0.19-4.93]). Conclusions: Systemic corticosteroids may be effective in treating dyspnea in patients with cancer, particularly those with lung involvement. Limiting the conditions for which corticosteroids are approved is expected to promote their appropriate use and minimize their adverse effects. However, further investigation is needed to determine the appropriate dosage, and the conditions in which corticosteroids are effective.

Splenic pseudoaneurysm rupture is a serious condition that sometimes leads to death. Pseudoaneurysm rupture is often treated with transcatheter arterial embolization (TAE), after which the re-rupture rate is 18%–37%. A 59-year-old man presented with back pain, and contrast-enhanced computed tomography (CECT) revealed pancreatic tail cancer with multiple liver metastases. After three courses of chemotherapy, CECT revealed good response with shrinkage of the tumors. However, the patient had back pain and CECT revealed pancreatic pseudocyst with pseudoaneurysm rupture. He underwent angiography, wherein the splenic artery pseudoaneurysm was embolized using TAE. Subsequently, pseudocyst drainage was performed using lumen-apposing metal stent (LAMS) to prevent pseudoaneurysm re-rupture. Thereafter, the pseudocyst shrieked with decreased serum levels of C-reactive protein, allowing the patient to re-institute chemotherapy. Pseudocyst drainage using LAMS was safe and effective when the pancreatic pseudoaneurysm had a high-risk rebleeding due to exposure to pancreatic juice.

The treatment of carotid stenosis complicated by severe vessel tortuosity can present challenges in distal vessel selection and device delivery. This article reports the use of a steerable microcatheter (SM) for carotid artery stenting (CAS) in such cases. A 67-year-old male with transient lower extremity weakness and bilateral cerebral infarctions was found to have bilateral carotid stenosis. CAS was planned for both carotid arteries due to coronary artery disease. The left carotid artery exhibited severe stenosis with a 90-degree angle between the common and internal carotid artery (ICA). Anticipating difficulty in navigating the device, we used a 2.4 Fr SM. By adjusting the catheter tip to align with the ICA, we successfully guided the wire distally. Following the catheter exchange, a distal protection device was deployed, and CAS was completed successfully. SMs provide exceptional vascular selectivity and support, improving success in complex cases.

Splenic pseudoaneurysm rupture is a serious condition that sometimes leads to death. Pseudoaneurysm rupture is often treated with transcatheter arterial embolization (TAE), after which the re-rupture rate is 18%–37%. A 59-year-old man presented with back pain, and contrast-enhanced computed tomography (CECT) revealed pancreatic tail cancer with multiple liver metastases. After three courses of chemotherapy, CECT revealed good response with shrinkage of the tumors. However, the patient had back pain and CECT revealed pancreatic pseudocyst with pseudoaneurysm rupture. He underwent angiography, wherein the splenic artery pseudoaneurysm was embolized using TAE. Subsequently, pseudocyst drainage was performed using lumen-apposing metal stent (LAMS) to prevent pseudoaneurysm re-rupture. Thereafter, the pseudocyst shrieked with decreased serum levels of C-reactive protein, allowing the patient to re-institute chemotherapy. Pseudocyst drainage using LAMS was safe and effective when the pancreatic pseudoaneurysm had a high-risk rebleeding due to exposure to pancreatic juice.

The treatment of carotid stenosis complicated by severe vessel tortuosity can present challenges in distal vessel selection and device delivery. This article reports the use of a steerable microcatheter (SM) for carotid artery stenting (CAS) in such cases. A 67-year-old male with transient lower extremity weakness and bilateral cerebral infarctions was found to have bilateral carotid stenosis. CAS was planned for both carotid arteries due to coronary artery disease. The left carotid artery exhibited severe stenosis with a 90-degree angle between the common and internal carotid artery (ICA). Anticipating difficulty in navigating the device, we used a 2.4 Fr SM. By adjusting the catheter tip to align with the ICA, we successfully guided the wire distally. Following the catheter exchange, a distal protection device was deployed, and CAS was completed successfully. SMs provide exceptional vascular selectivity and support, improving success in complex cases.