PURPOSE: To report experience on the use of self-closing nitinol U-Clips for different types of intracranial arterial microanastomosis. METHODS: We treated 7 patients (3 females and 4 males, age ranging from 25 to 68 yo) admitted from November 2005 to January 2008 to the Neurological Institute C. Besta of Milan. ...

Summary: Angioplasty and stenting are emerging alternative treatments to endarterectomy for carotid stenosis. The increasing number of procedures performed carries an increased diagnosis rate of associated asymptomatic intracranial aneurysms, resulting in a clinical and therapeutic dilemma, not fully solved in the literature. When an incidental lesion is found, the first ...

It is accepted that endovascular treatment for intracranial aneurysms < 2 cm in diameter is not an alternative option to surgical treatment anymore but has rather gained the place as the first therapeutic option. Still, the long-term efficacy of endovascular aneurysm treatment remains uncertain. This article discusses clinical significance, incidence, ...

A ruptured abdominal aortic aneurysm is an emergency anywhere in the world. Physician expertise and clinical status of the patient drive the treatment modalities in the majority of cases. Independent of treatment choice, the goal of therapy is to stabilize the patient as quickly as possible in a manner that ...

Endovascular stent grafts have become a viable treatment for aortic thoracic and abdominal aneurysms in both elective and emergent situations. Computed tomographic (CT) angiography is the primary tool for determining eligibility for this procedure. This article discuses the preprocedural evaluation of an endovascular stent candidate. Evaluation begins with identification of ...

The advent of endovascular therapy for intracranial aneurysms and the rapid advances in that field have supplanted microsurgical treatment for many intracranial aneurysms. Applying current outcome data and other parameters, nuances of selecting the modality of treatment for intracranial aneurysms are reviewed. Patient factors, such a age, co-morbidities, vasospasm and ...

BACKGROUND AND PURPOSE: Smoking and hypertension are important risk factors for atherosclerotic carotid artery disease, but also for intracranial aneurysms. We studied the presence of aneurysms in a series of patients with internal carotid artery (ICA) stenosis and performed a systematic review of the literature to assess in patients with ...

Acute occlusion of cervical or intracranial arteries is the most common cause of ischemic stroke (IS). The aims of the current study were to compare the occurrence of acute pathologic findings in intracranial arteries using transcranial color-coded sonography (TCCS) and computed tomographic angiography (CTA) performed within 3 hours of IS ...

The rupture of cerebral arterial aneurysm is an extremely rare cause of intracranial hemorrhage in infants. Brain magnetic resonance imaging is an excellent technique commonly used to suggest the diagnosis. In this article, we propose color flow Doppler ultrasound as a useful, simple, inexpensive, noninvasive, and accessible option for confirming ...

The review critically appraises the available evidence and current rationale for treating incidental intracranial aneurysms. The rationale for treating incidental intracranial aneurysms uses comparisons between the so-called natural history, provided in a recent meta-analysis, and risks of treatments. Some risk factors for ruptures were identified (age >60, female sex, size ...

Extracranial-to-intracranial bypass is used for flow replacement and diversion that prevent the serious complications associated with sudden ligation of the middle cerebral artery for treatment of complex tumors or aneurysms. Extracranial-to-intracranial bypass is a demanding procedure that requires experience in advanced microsurgical techniques. In this article, the authors review the ...

OBJECT: The development of self-expanding stents dedicated to intracranial use has significantly widened the applicability of endovascular therapy to many intracranial aneurysms that would otherwise have been untreatable by endovascular techniques. Recent Food and Drug Administration approval of the Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has added a ...

Over the past decade, uterine artery embolization (UAE) has become a popular alternative treatment for women with symptomatic fibroids who desire uterine preservation and/or the avoidance of surgical intervention. In this article, the history of UAE, preprocedure patient evaluation and patient selection, procedure technique, and expected UAE outcomes are reviewed.

Stroke is the world's third leading cause of death. One cause of stroke, intracranial aneurysm, affects approximately 2% of the population and accounts for 500,000 hemorrhagic strokes annually in mid-life (median age 50), most often resulting in death or severe neurological impairment. The pathogenesis of intracranial aneurysm is unknown, and ...

Tuberous sclerosis complex is a protean, genetically determined disease that may involve any organ or tissue and lead to a great number of signs and clinical features. Occlusive vascular disease and aneurysms of the cerebral and visceral arteries were described in these patients. We report on an 8-month-old boy who ...

ABSTRACTOBJECTIVETo review the current knowledge of screening and treatment of asymptomatic unruptured intracranial aneurysms (AUIAs) using a case-based approach.SOURCES OF INFORMATIONPubMed was searched from January 1995 to January 2008 using the phrase unruptured intracranial aneurysm. Scientific statements of the Stroke Council of the American Heart Association pertaining to intracranial aneurysms ...

BACKGROUND: Sixteen-row multislice CT has great potential for use in vascular studies. The aim of the study was to assess the diagnostic accuracy of 16-row multislice CTA in detecting intracranial aneurysms compared with 2D-DSA and surgical findings. METHODS: One hundred fifty-two consecutive patients were included in the study and successively ...

BACKGROUND AND PURPOSE: Reocclusion of intracranial arteries after successful recanalization is associated with poor clinical outcome. The role of Factor V Leiden mutation in intracranial arterial thrombosis/rethrombosis is unclear. SUMMARY OF REPORT: We report the case of a patient who developed recurrent reocclusions of the middle cerebral artery after intra-arterial ...

PURPOSE: Intracranial aneurysms are relatively rare in the pediatric population. The objective of this study was to highlight the clinical and radiological features and the therapeutic outcome and clarify the choice of therapeutic strategies for pediatric intracranial aneurysms. MATERIALS AND METHODS: Twenty-four consecutive children (age <or=14 years) who were diagnosed ...

BACKGROUND: We hope to illustrate the feasibility of endovascular recanalization for intracranial symptomatic arterial occlusion in the subacute period without adjunctive stenting. CASE DESCRIPTION: Two patients presented with recurrent transient ischemic attacks due to subacute occlusion of intracranial vessels (left MCA M1 and basilar artery). Both had pressor-dependent ischemic symptoms ...

The aim of this document is to summarize the existing data derived from regulatory bodies, professional organizations, and clinical trials with direct pertinence to indications and qualifications required for performing neurointerventional procedures and provide recommendations regarding qualifications required for performing individual neurointerventional procedures. Recommendations are provided for performance of cerebral ...

INTRODUCTION: Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. MATERIALS AND METHODS: All patients treated with abciximab during (41 patients) or ...

The double origin of the posterior inferior cerebellar artery (PICA) is a variant anastomosis of a residual lateral spinal artery and native intracranial PICA that has been associated with intracranial aneurysm formation. Because of this anastomosis, both origins of the PICA serve as aneurysmal-feeding vessels. We describe a novel technique ...

Leiomyomas (or fibroids) are exceedingly common lesions. The indications to initiate treatment are based on the symptoms that can arise from their presence. In general, medical therapy should be considered the first line of treatment. Currently, the treatment of fibroids is in evolution. Since uterine artery embolization (UAE) was first ...

Bronchial artery bleeding is the most common cause of life-threatening hemoptysis. The most common underlying etiologies include tuberculosis, bronchiectasis, aspergillosis, and cystic fibrosis. Bronchial artery embolization is an important treatment for significant hemoptysis, given its high early success rate and relatively low risk compared with alternative medical and surgical treatments. ...

A 56-year-old woman presented to our hospital with acute severe asthma. As a consequence of severe refractory airflow limitation, moderate hypercapnia ensued for several days. Unexpectedly, the patient died as a result of brain stem herniation, in the absence of hypoxaemia, arterial hypotension or an intracranial mass lesion. We discuss ...

Vascular anomalies are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or, more often, in combination. Although mostly congenital, they can occasionally be acquired as well. They present a challenge both for workup and therapy. This article attempts to describe some of their ...

AIM: Nowadays endovascular therapy is more and more considered as first choice treatment for ruptured intracranial aneurysms. The aim of this study was to understand the impact that endovascular treatment (EVT), chosen as first therapeutic strategy, has had in the selection of ruptured intracranial aneurysms submitted to surgery at our ...

Summary: The pathogenesis of intracranial arterial aneurysms (AA) has been debated for many years and still remains unclear, although these entities might pose life-threatening risks to the patient and understanding the disease is of utmost importance for choosing treatment concepts. Apart from the "classical" berry-type aneurysm, there are different other ...

Abstract: Background and purpose: To summarize the theoretical background and existing technical achievements of flow modification techniques in the treatment of intracranial aneurysms. The evolution of the concept of flow modification for aneurysm treatment is overviewed within the published literature on application of stents for aneurysms. The newest achievements using ...

OBJECTIVE: We describe our initial experience with the use of a novel, compliant guide catheter designed for placement within the cranial vasculature in a series of seven patients who were treated for various intracranial pathologies. CLINICAL PRESENTATION: Seven patients were deemed to have either tortuous supra-aortic, intracranial, and/or extracranial vasculature ...

We describe for the first time a case of intracranial tuberculoma with adjacent intracerebral inflammatory aneurysms, and include a brief discussion of the developmental mechanism of these pathologies. A 28-year-old woman presented with a history of intermittent seizure attacks. She had been diagnosed as having pulmonary tuberculosis 1 year previously, ...

OBJECT: The annual rate of rupture of intracranial aneurysms is often assumed to be constant, but it is unknown whether this assumption is true. Recent case reports have suggested that aneurysms grow fast in a short period of time. The authors of the present report investigated the plausibility of a ...

We report a case of spontaneous subdural haematoma due to ruptured intracranial infectious aneurysm, presenting with bilingual aphasia and illustrating differential language recovery. A 62-year-old right-handed bilingual gentleman, with a diagnosis of infective endocarditis, developed headache and became expressively aphasic in the English language. Three days later he was receptively ...

Up to 5% of the population may have an intracranial aneurysm, although many of these people are unaware of its presence. Most intracranial aneurysms remain asymptomatic, but a small proportion of them will rupture and bleed, causing life-threatening complications. Once diagnosed, treatment of aneurysms may include surgery or a minimally ...

In neurosurgical practice, extradural or subgaleal drains are commonly placed and connected to a vacuum system. Several reports have described severe bradycardia or arterial hypotension, or both, after connection of negative suction pressure to the extradural or epicranial drains following craniotomy. We encountered an unusual complication with the use of ...

The treatment of giant aneurysms remains a formidable challenge for endovascular and surgical strategies. The use of endovascular techniques in a deconstructive (e.g., parent vessel occlusion) and reconstructive (e.g., stent coiling) methodology is reviewed. The results of endovascular coiling as a primary therapy for giant aneurysm occlusion have been disappointing. ...

This study evaluated the changes in blood flow velocity in the anterior and posterior intracranial circulations according to the progression of moyamoya disease in adult patients. We evaluated Suzuki's angiographic stage and mean blood flow velocity (MBFV) changes in intracranial vessels from both sides in 19 adult moyamoya patients. We ...

BACKGROUND: Strokes related to intracranial aneurysm or arteriopathy have been reported in a few patients with late-onset Pompe disease. These reports suggested that cerebral vessel involvement could be an underrecognized complication of this disease. METHODS: We report cerebral artery involvement in three French patients with late-onset Pompe disease. RESULTS: The ...

Intracranial stenting, with or without balloon angioplasty, has emerged as an effective alternative to medical therapy for intracranial atherosclerosis. However, this strategy appears to involve the potential risk of distal embolization, which may lead to disability and death. Here, the authors have described a successful case of distal balloon-protected intracranial ...

Computational fluid dynamics (CFD) modeling of nominally patient-specific cerebral aneurysms is increasingly being used as a research tool to further understand the development, prognosis, and treatment of brain aneurysms. We have previously developed virtual angiography to indirectly validate CFD-predicted gross flow dynamics against the routinely acquired digital subtraction angiograms. Toward ...

RATIONALE AND OBJECTIVES: To evaluate the potential benefits, harms, and cost-effectiveness of screening for asymptomatic, unruptured intracranial aneurysms in family members of patients with aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: Using a Markov model, we performed a decision and cost-effectiveness analysis comparing magnetic resonance (MR) angiography screening for asymptomatic, ...

OBJECTS: Infectious intracranial aneurysms present a treatment challenge in the pediatric population. Current endovascular strategies and tools have been developed, which make treatment of infectious intracranial aneurysms with liquid embolics safe and effective. This study reviews the use of the liquid embolic Onyx in the treatment of infectious intracranial aneurysms ...

It is extremely rare that nonsaccular intracranial aneurysms are located at the cerebellopontine angle. A 60-year-old woman presented with dizziness and left-sided sensorineural hearing loss that had developed gradually for 6 months. Magnetic resonance imaging scan and magnetic resonance angiography revealed that the basilar artery was ectatic and markedly displaced ...

BACKGROUND: Although extracranial carotid dissection with stroke is common, intracranial dissection with stroke is rare. Stenting has been used to treat extracranial carotid dissections. Intracranially, however, it is only recently that stents have become a feasible option for this disease. We present a case of a spontaneous intracranial CAD with ...

BACKGROUND: We propose a set of criteria for diagnosis of intracranial infectious aneurysm (IA). The proposed diagnostic criteria contain a mandatory criterion (demonstration of intracranial aneurysm by neuroimaging) and 12 supportive criteria drawn from three domains. Domain A encompasses infection, such as infective endocarditis, meningitis, cavernous sinus thrombophlebitis or orbital ...

BACKGROUND: The reasons for development of intracranial aneurysms are unknown; hemodynamic factors may play an important role in this process. We performed a cohort study to further elicit the role of intracranial arterial geometry. METHODS: We compared the original CTA/MRA of the circle of Willis of 26 patients who developed ...

BACKGROUND: Heidelberg Retina Tomograph is a scanning laser ophthalmoscope that is routinely used for the assessment and serial measurement of optic nerve morphology and nerve fiber layer anatomy in the setting of elevated intraocular pressure typically encountered in glaucoma. Recent studies have explored the use of this device in the ...

Fibromuscular dysplasia (FMD) is an arterial disease of unknown etiology. Most often it affects the renal and internal carotid arteries (ICA), although any artery can be involved. Internal carotid arteries are affected in 25-30% of patients. When carotid arteries are involved, cervical segments C1-C2 are most often affected. FMD of ...

Double fenestration of the anterior communicating artery (ACoA) complex associated with an aneurysm is a very rare finding and is usually caused by ACoA duplication and the presence of a median artery of the corpus callosum (MACC). We present a patient in whom double fenestration was not associated with ACoA ...