magnetically-assisted-remote-controlled-microcatheter-tip-deflection

Magnetically-Assisted Remote Controlled Microcatheter Tip Deflection under Magnetic Resonance Imaging

X-ray fluoroscopy-guided  endovascular procedures have several significant limitations, including  difficult catheter navigation and use of ionizing ...

Prior to interventional neuroradiology procedures, many patients undergo noninvasive studies such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA). The ability to use these studies during invasive neuroangiographic procedures reduces additional contrast and radiation exposure, and allows for the integration of extravascular imaging.

Endovascular procedures with CTA and MRA roadmapping.

Complex intracranial aneurysms are often treated with endovascular stent-assisted coiling. Intracranial stents are difficult to visualize with conventional computed tomography (CT) or fluoroscopy. "Stent view" flat-detector CT can be used to visualize intracranial stents during endovascular treatment.

"Stent view" flat-detector CT and stent-assisted treatment strategies for complex intracranial aneurysms.

Dural arteriovenous fistulas (dAVFs) are a complex family of vascular malformations. Most series discuss features in isolation of other vascular pathologies, despite evidence that dAVFs may arise in a setting of elevated angiogenic growth factors related to regional hypoxia. We describe a 72-year-old man with ischemic symptoms secondary to middle cerebral artery stenosis and an incidental ipsilateral Borden I dAVF. Balloon-occlusion single photon emission computed tomography demonstrated reversible ischemia within the basal ganglia consistent with fistula-related "steal" phenomenon. This case supports the hypothesis that dAVFs may arise secondary to angiogenic growth factors related to regional tissue hypoxia.

Synchronous chronic middle cerebral artery occlusion and ipsilateral dural arteriovenous fistula.

Flat panel detector CT (FD-CT), three-dimensional image overlay and navigation software on contemporary fluoroscopic units generate less radiation dose while performing imaging of comparable quality to conventional CT. They can superimpose MR and CT datasets and can accurately guide percutaneous procedures providing live instrument visualization and the capability of re-imaging without patient transfer. These techniques, however, have been minimally used for accessing the head.

Intraorbital access using fluoroscopic flat panel detector CT navigation and three-dimensional MRI overlay.

Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic vasculopathy typically affecting the abdominal arteries although it may also affect the great vessels and cerebral vasculature. Diseased vessels manifest with aneurysms and/or dissections, often presenting clinically with catastrophic thromboembolic injury and less frequently with subarachnoid hemorrhage (SAH). The etiology of SAM remains indeterminate although there is evidence it may be an endogenous pathological response to vasospasm. The SAM literature is reviewed and a case of SAH related to a ruptured dissecting-type vertebral artery aneurysm is described. In addition to furthering awareness of SAM, this unique case offers insight into the acute phase of the disease and the potential role of vasospastic induction.

Serial angiographic appearance of segmental arterial mediolysis manifesting as vertebral, internal mammary and intra-abdominal visceral artery aneurysms in a patient presenting with subarachnoid hemorrhage and review of the literature.

Segmentale arterielle Mediolysis (SAM) ist eine seltene, nicht-entz&uuml;ndliche, nicht-atherosklerotische Vaskulopathie, normalerweise die abdominalen Arterien beeinflussen, obwohl es auch die gro&szlig;en Gef&auml;&szlig;e und zerebraler Gef&auml;&szlig;e auswirken kann. Kranke Gef&auml;&szlig;e manifestieren mit Aneurysmen und/oder sezieren, oft klinisch mit katastrophalen thromboembolische Verletzungen und weniger h&auml;ufig mit Subarachnoidalblutung (SAB) pr&auml;sentieren. Die &Auml;tiologie von SAM ist unbestimmt, obwohl es Beweise, dass es m&ouml;glicherweise eine endogene pathologische Reaktion auf Vasospasmus. Die SAM-Literatur wird &uuml;berpr&uuml;ft und ein Fall von SAH bezogene zu einem geplatzten sezieren-Typ vertebrale Arterie Aneurysma beschrieben wird. Neben F&ouml;rderung Bewusstsein f&uuml;r SAM bietet dieses einzigartige Fall Einblick in der akuten Phase der Erkrankung und der m&ouml;glichen Rolle der vasospastische Induktion.

Serielle angiographischen Darstellung der segmentale arterielle Mediolysis manifestiert sich als vertebral, interne Milch- und intra-abdominalen viszeralen Arterie Aneurysmen in einem Patienten mit Subarachnoidalblutung und &Uuml;berblick &uuml;ber die Literatur pr&auml;sentieren.

Can lysability of large vessel thrombi in acute ischemic stroke be predicted by measuring clot density on admission nonenhanced CT (NECT), postcontrast enhanced CT, or CT angiogram (CTA)?

Density of thrombus on admission CT predicts revascularization efficacy in large vessel occlusion acute ischemic stroke.

BACKGROUND: The role of catheter angiography in the diagnosis and management of traumatic cerebrovascular injury has evolved rapidly with advances in CT and MR angiography and continued development of endovascular techniques. OBJECTIVE: To identify the modern spectrum of traumatic arterial injury encountered during catheter neuroangiography and to examine current patterns of endovascular treatment. METHODS: Records of trauma patients undergoing catheter neuroangiography over a 4 year period at two high volume centers were retrospectively reviewed. The sample comprised 100 separate arterial lesions that were classified according to mechanism, location, acuity, and endovascular treatment. Follow-up imaging and clinical notes were reviewed to identify procedural complications. RESULTS: Of 100 arterial lesions, 81% were related to blunt trauma. Distribution of lesions by location was 42% intracranial, 39% cervical, and 19% extracranial. The most common injuries were pseudoaneurysm (38%), fistula (29%), and dissection (19%). In total, 41% of lesions underwent endovascular treatment, with trends favoring treatment of non-acute, penetrating, non-cervical, and high grade lesions. Therapy involved coil embolization for 89% of treated lesions. There were a total of two immediate neurovascular complications and one delayed neurovascular complication; one of these resulted in a permanent neurological deficit. CONCLUSIONS: Our experience in a large cohort of patients suggests that a relatively high proportion of traumatic arterial lesions identified by catheter angiography are treated by endovascular means, with a low rate of immediate and delayed neurovascular complications.

Article	Year
Endovascular procedures with CTA and MRA roadmapping. Journal of neuroimaging : official journal of the American Society of Neuroimaging\| PubMed ID: 20649854	2011
"Stent view" flat-detector CT and stent-assisted treatment strategies for complex intracranial aneurysms. World neurosurgery\| PubMed ID: 21492730	2011
Synchronous chronic middle cerebral artery occlusion and ipsilateral dural arteriovenous fistula. Clinical nuclear medicine\| PubMed ID: 21637062	2011
Intraorbital access using fluoroscopic flat panel detector CT navigation and three-dimensional MRI overlay. Journal of neurointerventional surgery\| PubMed ID: 21990636	2010
Serial angiographic appearance of segmental arterial mediolysis manifesting as vertebral, internal mammary and intra-abdominal visceral artery aneurysms in a patient presenting with subarach... Journal of neurointerventional surgery\| PubMed ID: 22693248	2012
Density of thrombus on admission CT predicts revascularization efficacy in large vessel occlusion acute ischemic stroke. Stroke; a journal of cerebral circulation\| PubMed ID: 23111438	2013
Current trends in endovascular management of traumatic cerebrovascular injury. Journal of neurointerventional surgery\| PubMed ID: 23322749	2013

Daniel L. Cooke

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