Endovascular treatment of a cervical paraspinal arteriovenous malformation via arterial and venous approaches.
(25/1139)
We describe a cervical congenital paraspinal arteriovenous malformation (AVM) drained by paraspinal and epidural ectatic veins, which caused massive erosion of the C6 and C7 vertebral bodies, threatening the cervical stability and necessitating treatment. During the first session, six arterial embolizations were performed to reduce the size and the flow of the AVM. Two months later, a venous approach was used to occlude the remnant venous exit of the AVM and achieve a complete cure. All embolizations were performed using N-butylcyanoacrylate. (+info)
Microdroplet tracking using biplane digital subtraction angiography for cerebral arteriovenous malformation blood flow path and velocity determinations.
(26/1139)
High-speed biplane angiography is used to determine the path and velocity of microdroplets of contrast material in three dimensions. By allowing more accurate determination of detailed blood flow in feeding vessels and draining veins of cerebral arteriovenous malformations than available with standard angiography, the new method offers the potential for more accurate treatment and further study of neurovascular/cerebrovascular hemodynamics. The first study of the method is presented. (+info)
Embolization of the meningohypophyseal trunk as a cause of diabetes insipidus.
(27/1139)
We present an unusual case of diabetes insipidus occurring after selective embolization of 50% dextrose and pure ethanol into an enlarged left meningohypophyseal trunk (MHT) supplying a dural carotid cavernous fistula. The inferior hypophyseal artery was not opacified during the selective preembolization MHT injection; however, diabetes insipidus developed abruptly a few hours after the procedure. The patient required intranasal 1-deamino-(8-D-arginine)-vasopressin for approximately 3 months, after which his symptoms resolved. The hazards of using liquid embolic agents, especially ethanol, in the cavernous branches of the internal carotid artery should always be borne in mind. (+info)
Pseudoaneurysm of the left ventricle progressing from a subepicardial aneurysm.
(28/1139)
A 56-year-old man presented with an inferior myocardial infarction and a huge pseudoaneurysm below the inferior surface of the left ventricle, which had progressed from a small subepicardial aneurysm over a 6-month period. Transthoracic echocardiography, Doppler color flow images, radionuclide angiocardiography, magnetic resonance imaging and contrast ventriculography all revealed an abrupt disruption of the myocardium at the neck of the pseudoaneurysm, where the diameter of the orifice was smaller than the aneurysm itself, and abnormal blood flows from the left ventricle to the cavity through the orifice with an expansion of the cavity in systole and from the cavity to the left ventricle with the deflation of the cavity in diastole. Coronary angiography revealed 99% stenosis at the atrioventricular nodal branch of the right coronary artery. At surgery the pericardium was adherent to the aneurysmal wall and a 1.5-cm orifice between the aneurysm and the left ventricle was seen. Pathological examination revealed no myocardial elements in the aneurysmal wall. The orifice was closed and the postoperative course was uneventful. Over-intense physical activity as a construction worker was considered to be the cause of the large pseudoaneurysm developing from the subepicardial aneurysm. These findings indicate that a subepicardial aneurysm may progress to a larger pseudoaneurysm, which has a propensity to rupture, however, it can be surgically repaired. (+info)
Definition of the ostium (neck) of an aneurysm revealed by intravascular sonography: an experimental study in canines.
(29/1139)
BACKGROUND AND PURPOSE: The major factor influencing the effectiveness of Guglielmi detachable coils (GDCs) in the treatment of saccular aneurysms is the size of the aneurysm's ostium (neck). Current imaging techniques often do not allow accurate assessment of aneurysm neck morphology. The primary purpose of this study was to determine the feasibility of using intravascular sonography to provide this information. METHODS: Lateral and bifurcation aneurysms were created in each of six adult mongrel dogs by using a well-established surgical technique. Aneurysms were evaluated with digital subtraction angiography and intravascular sonography before (n = 12) and after (n = 6) treatment with GDCs. Angiography was performed using standard techniques. Sonography was performed using both a commercially available 2.6F 40-MHz catheter and a preproduction 0.014-inch 40-MHz imaging core wire housed in a Tracker catheter. Angiograms and sonograms were reviewed independently by two observers to assess the clarity and accuracy with which they depicted the size of each aneurysm's ostium. Posttreatment intravascular sonograms were evaluated for the extent to which they depicted the completeness of aneurysm obliteration. Two-dimensional reformatted images were made of the intravascular sonographic pullback sequences. RESULTS: In all instances, intravascular sonography provided clear definition of the aneurysm's neck (ostium) morphology as well as its relationship to the parent artery and adjacent branches, especially when 2D reformatted images were obtained. The position of coils in aneurysms was also clearly defined. CONCLUSION: Intravascular sonography is a novel technique for viewing the ostium (neck) of an aneurysm. It provides information not available with current angiographic methods. (+info)
Polyangiitis overlap syndrome with eosinophilia associated with an elevated serum level of major basic protein.
(30/1139)
Polyangiitis overlap syndrome is a new disease entity and the reported cases in the literature are still limited. We describe a female patient presenting with finger ulcers, skin eruptions, pleural effusion, interstitial pneumonia and eosinophilia. Skin biopsy showed systemic small-sized angiitis and thrombosis. She was diagnosed as having polyangiitis overlap syndrome and was successfully then treated with corticosteroid. It is also of interest that the disease activity was correlated with the number of eosinophils in peripheral blood. The measurement of the serum level of major basic protein released from eosinophils functioning as a coagulant indicated the possible association of eosinophilia with thrombosis and polyangiitis. (+info)
Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms.
(31/1139)
Iatrogenic aneurysms are usually postcatheterisation pseudoaneurysms of the femoral artery. Until recently, the treatment of choice was ultrasound guided compression repair. A case of pseudoaneurysm of the axillary artery, arising as a complication of pacemaker insertion in an 83 year old man is reported. Compression repair was not possible in this case, and so the aneurysm was occluded by percutaneous ultrasound guided thrombin injection directly into the aneurysm sac. Percutaneous ultrasound guided thrombin injection is a promising new minimally invasive technique for the treatment of iatrogenic pseudoaneurysms. (+info)
Three-dimensional transcranial color-coded sonography of cerebral aneurysms.
(32/1139)
BACKGROUND AND PURPOSE: The role of 2-dimensional transcranial color-coded sonography (2D-TCCS) as a diagnostic tool in cases of vascular alteration is unquestioned. The skill of the operator, however, may be responsible for some intertrial variability. The clinical value of a new, workstation-based, 3D reconstruction system for TCCS was evaluated in patients with intracranial aneurysms. METHODS: Thirty patients with 30 intracranial aneurysms were investigated (8 men, 22 women; mean+/-SD age 54+/-17 years). The TCCS examinations were performed with a 2-MHz probe using the power mode. The 3D system (3D-Echotech, Germany) consisted of an electromagnet, which induced a low-intensity magnetic field near the head of the patient. A magnetic position sensor was attached to the ultrasound probe and transmitted the spatial orientation of the probe to a workstation, which also received the corresponding 2D-images from the video-port of the duplex machine. The echo contrast enhancer D-galactose (Levovist, Schering, Germany) was used in all patients to improve the signal-to-noise ratio. All patients underwent presurgical digital subtraction angiography (DSA) to demonstrate the aneurysm. RESULTS: Twenty-nine of 30 angiographically proven intracranial aneurysms (97%) were detected by 3D-TCCS. The aneurysmal diameter estimated by DSA ranged from 3 to 16 mm (mean 7. 2+/-3.6 mm). A comparison of the 3 main diameters of each aneurysm revealed a correlation coefficient of 0.95 between DSA and 3D-TCCS. The 3D determination of the aneurysmal size by 2 experienced sonographers correlated with 0.96. CONCLUSIONS: 3D-TCCS is a new, noninvasive method to investigate intracranial aneurysms. The differentiation between artifacts and true changes of the vessel anatomy is much easier in 3D-TCCS than in conventional 2D-TCCS. The new method yields an excellent correlation with the gold standard, DSA. Because the same 3D-TCCS data can be postprocessed by different investigators, it may be possible to improve reproducibility and increase the objectivity of transcranial color-coded duplex sonography. (+info)