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Sample records for posterior circulation aneurysms

  1. Endovascular treatment of unruptured posterior circulation intracranial aneurysms

    PubMed Central

    Lv, Xianli; Ge, Huijian; Jin, Hengwei; He, Hongwei; Jiang, Chuhan; Li, Youxiang

    2016-01-01

    Background and Purpose: Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs) is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA). The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs. Materials and Methods: Retrospective analysis of all patients treated in a 2-year period (89 patients: 10–78 years of age, mean: 45.5 ± 14.3/92 UPCIAs). Fifty-eight aneurysms were found incidentally, 12 in association with mass effect symptoms and 22 with stroke. Results: A clinical improvement or stable outcome was achieved in 84 patients (94.4%). The two cases of permanent morbidity included a patient with paralysis and another patient with hemianopia. One patient died after treatment of a giant fusiform vertebrobasilar aneurysm. In one patient, the aneurysm ruptured during treatment, resulting in death. Another patient suffered a fatal aneurysm rupture 4 days after treatment. Giant size (P = 0.005) and mass effect presentation (P = 0.029) were independent predictors of unfavorable outcomes in UPCIAs. Angiographic follow-up was available in 76 of the 86 surviving patients (88.4%) with a mean of 6.8 months (range: 1–36 months). Recanalization in six patients (7.9%) at 3 months, 4 months, 4 months, 24 months, and 36 months required retreatment in three patients. In-stent stenosis of >50% was found in three patients. Conclusion: Endovascular therapy is an attractive option for UPCIAs with stable midterm outcome. However, the current endovascular option seems to have a limitation for the treatment of the aneurysm with giant size or mass effect presentation. PMID:27570378

  2. A ruptured aneurysm arising at the leptomeningeal collateral circulation from the extracranial vertebral artery to the posterior inferior cerebellar artery associated with bilateral vertebral artery occlusion.

    PubMed

    Chonan, Masashi; Nishimura, Shinjitu; Kimura, Naoto; Ezura, Masayuki; Uenohara, Hiroshi; Tominaga, Teiji

    2014-02-01

    We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to the VA union. In addition, a small aneurysm was observed at the leptomeningeal collateral circulation located between the extracranial left VA and the left PICA. The patient underwent radical surgery on the day of the onset of the symptoms associated with SAH. However, the VA aneurysm was unruptured and surgically trapped. The small aneurysm arising at the leptomeningeal collateral circulation was ruptured during the surgery and was electrocoagulated; the collateral circulation was preserved, and no neurologic deficits were observed. The postoperative course was uneventful. SAH with the occlusion of major vessels should be diagnosed with utmost caution to allow preoperative neurologic and radiological assessments.

  3. Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion.

    PubMed

    Matsumura, Hideaki; Kato, Noriyuki; Fujiwara, Yusuke; Hosoo, Hisayuki; Yamazaki, Tomosato; Yasuda, Susumu; Matsumura, Akira

    2016-10-01

    We present a retrospective analysis of endovascular treatments for posterior cerebral artery (PCA) aneurysms and discuss the susceptibility of a fetal-type PCA to vascular insufficiency after parent artery occlusion. Among 1207 aneurysms treated with endovascular therapy between March 1997 and March 2013 in our institution, 10 patients (0.8%) presented PCA aneurysms. The principal strategy was to employ selective coil embolization for the aneurysm. However, in certain cases of fusiform or dissecting aneurysms, we performed parent artery occlusion with coils. Clinical and radiological data were collected from hospital charts and evaluated retrospectively. The mean age was 52.7±15.6years (range, 12-65years). Five patients (50%) were admitted with a subarachnoid hemorrhage, and one patient presented with slowly developing paralysis. The remaining four patients were diagnosed incidentally. Five patients underwent selective coil embolization, and five patients underwent parent artery occlusion. All endovascular therapies were successfully performed. However, two patients in the parent artery occlusion group suffered cerebral infarction, and both patients exhibited a fetal-type PCA. The remaining three patients in the parent artery occlusion group exhibited an adult-type PCA and did not suffer a cerebral infarction. Endovascular treatment with either selective coil embolization or parent artery occlusion is safe and effective as the long as the anatomical type of the PCA is considered. Patients with a fetal-type PCA may develop vascular insufficiency upon parent artery occlusion. Neurosurgeons should attempt to preserve the parent artery using a flow-diverting stent or stent-assisted technique for a fetal-type PCA aneurysm. PMID:27523585

  4. Retrograde Stent-assisted Coil Embolization of Wide-neck or Branch-incorporated Posterior Communicating Artery Aneurysm

    PubMed Central

    Park, Jeong Woo; Choi, Kyu Sun; Park, Dong Woo; Ryu, Je Il; Kim, Jae Min; Kim, Choong Hyun

    2016-01-01

    Endovascular coil embolization using a balloon- or stent-assisted technique for the treatment of wide-necked posterior communicating artery (PcomA) aneurysms is well established. However, complete aneurysm occlusion with preservation of the PcomA can be difficult in case of wide-neck aneurysms with a PcomA incorporation. We present two cases of stent-assisted coil embolization using a retrograde approach through the posterior circulation for wide-neck or branch-incorporated PcomA aneurysms. Retrograde stenting was successful without periprocedural complications. These aneurysms were completely occluded. The patency of the PcomA was maintained in all cases. PMID:27790404

  5. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child.

    PubMed

    Demartini, Zeferino; Matos, Luiz Afonso Dias; Dos Santos, Marcio Luis Tostes; Cardoso-Demartini, Adriane de Andre

    2016-01-01

    The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.

  6. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child.

    PubMed

    Demartini, Zeferino; Matos, Luiz Afonso Dias; Dos Santos, Marcio Luis Tostes; Cardoso-Demartini, Adriane de Andre

    2016-01-01

    The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding. PMID:26974558

  7. Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.

    PubMed

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2014-01-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision.

  8. Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.

    PubMed

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2015-07-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision.

  9. Endovascular coil embolization of unruptured posterior communicating artery aneurysm.

    PubMed

    Binning, Mandy; Hakma, Zakaria; Veznedaroglu, Erol

    2014-07-01

    The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1. The video can be found here: http://youtu.be/MjOc3Zpv2K8 . PMID:24983726

  10. Vertigo due to posterior circulation stroke.

    PubMed

    Kim, Ji Soo; Lee, Hyung

    2013-07-01

    Stroke in the distribution of the posterior circulation may present as acute onset spontaneous vertigo and imbalance. Although vertigo due to posterior circulation stroke is usually associated with other neurologic symptoms or signs, small infarcts in the cerebellum or brainstem can present with vertigo without other localizing symptoms. Approximately 17% of patients with isolated posterior inferior cerebellar artery territory infarction presented with isolated vertigo, nystagmus, and postural unsteadiness. A head impulse test can differentiate acute isolated vertigo associated with cerebellar stroke from more benign disorders involving the inner ear. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the anterior inferior cerebellar artery). In this case, evaluation of isolated audiovestibular loss may prevent the progression of acute vertigo and hearing loss into more widespread areas of infarction in the posterior circulation. In this article, the clinical syndromes and signs of acute vestibular syndrome due to posterior circulation stroke involving the brainstem and cerebellum are summarized.

  11. [Ruptured Internal Carotid Artery Aneurysm Coiling in a Patient with Ipsilateral Internal Carotid Artery Occlusion via the Posterior Communicating Artery].

    PubMed

    Ashida, Noriaki; Saitoh, Minoru; Fujita, Atsushi; Kohmura, Eiji

    2016-09-01

    Background:De novo aneurysms after internal carotid artery(ICA)occlusion occur in the contralateral ICA or anterior communicating artery. Hemodynamic changes with increased blood flow to the contralateral carotid circulation were considered the main factor for the formation of these aneurysms. We report a rare case of ruptured ICA aneurysm associated with ipsilateral ICA occlusion treated with coil embolization via the vertebrobasilar and posterior communicating arteries. Case Presentation:An 82-year-old woman presented with sudden-onset disturbance of consciousness at our outpatient clinic and went into cardiopulmonary arrest. Computed tomography(CT)performed after cardiopulmonary resuscitation revealed diffuse subarachnoid hemorrhage. Three-dimensional CT angiography revealed a right ICA aneurysm associated with the ipsilateral ICA occlusion. Considering that the patient showed clinical improvement with the critical care for neurogenic pulmonary edema, the aneurysm was treated with endovascular coil embolization via the posterior communicating artery. With this technique, complete obliteration was attained without perioperative complication. Conclusion:Endovascular coil embolization via the posterior communicating artery was proven effective as a treatment method for ruptured ICA aneurysms with ipsilateral ICA occlusion. Hemodynamic stress due to increased blood flow in the posterior communicating artery may play an important role in the growth and rupture of ICA aneurysms. PMID:27605482

  12. Clipping of ipsilateral posterior communicating and superior cerebellar artery aneurysms.

    PubMed

    Welch, Babu G

    2015-01-01

    The case is a 55-year-old female who presented with dizziness as the chief complaint. She has a family history of two relatives with subarachnoid hemorrhage. Digital subtraction angiography revealed the presence of a left-sided posterior communicating artery aneurysm and an ipsilateral superior cerebellar artery (SCA) aneurysm. Due to the smaller nature of the SCA, a decision was made to proceed with surgical clipping of both lesions through a pterional approach. A narrated video with illustrations depicts the intraoperative management of these lesions with postoperative angiography results. The video can be found here: http://youtu.be/HCHToSsXv-4 . PMID:25554845

  13. Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

    PubMed Central

    Tanweer, Omar; Thomas, Cheddhi; Engler, John; Shapiro, Maksim; Becske, Tibor

    2016-01-01

    Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature. PMID:27114966

  14. Resolution of third nerve palsy despite persistent aneurysmal mass effect after flow diversion embolization of posterior communicating artery aneurysms.

    PubMed

    Binyamin, Tamar R; Dahlin, Brian C; Waldau, Ben

    2016-09-01

    Posterior communicating artery (PCOM) aneurysms may cause third nerve palsies. The optimal treatment with clipping versus coiling remains controversial. Here we report on two cases of resolution of third nerve palsy after flow diversion embolization of large and giant PCOM aneurysms without adjuvant coil placement. The resolution of third nerve palsy was not preceded by significant shrinkage of the aneurysmal sac on MRI. However, one patient showed resolution of T2-weighted signal abnormalities in the midbrain and mesial temporal lobe despite a similar size of the aneurysm. Therefore, flow diversion embolization of a PCOM aneurysm may resolve oculomotor nerve palsies through decreasing arterial pulsations against the nerve or midbrain. PMID:27183957

  15. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion.

    PubMed

    Johnson, Andrew K; Tan, Lee A; Lopes, Demetrius K; Moftakhar, Roham

    2016-03-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail.

  16. Restoration of the pelvic circulation in patients with abdominal aortic aneurysms receiving aortobifemoral grafts.

    PubMed

    Cardia, G; Tumolo, R; Cafagna, L

    1998-04-01

    When operating on abdominal aortic aneurysms associated with stenoses or occlusions of iliac vessels, surgeons may face the problem of reestablishing circulation to pelvic or gluteal territories. A new technique consists of anastomosing a posterior opening in the body or one of the branches of a bifurcated graft, distally sutured to the femoral artery, to the distal aortic stump, which contains all the patent vessels arising from the end of the aorta, such as inferior mesenteric and lumbar arteries. This technique, successfully performed in two cases, has the advantages of avoiding closure of the distal aortic stump and a possible backflow leak and of ensuring adequate pelvic circulation. PMID:9576094

  17. Endovascular embolization of a giant aneurysm in medial posterior choroidal artery with associated arteriovenous malformation.

    PubMed

    Alshumrani, Ghazi Adlan; Al-Qahtani, Sultan

    2013-01-01

    A 16-year-old male adolescent who presented with vomiting and headache and in the emergency department had a loss of consciousness, was discovered to have a large mass compressing the brainstem. CT scan showed two adjacent mass lesions. Digital subtraction angiography (DSA) revealed a giant aneurysm in the posterior medial choroidal artery, subsequently embolized with Guglielmi detachable coils (GDCs). Ten GDCs were used to embolize the aneurysm and the distal aspect of its parent artery. Postembolization DSA confirmed complete embolization of the aneurysm. Endovasular embolization of giant aneurysms in the medial posterior choroidal artery with GDCs is technically feasible and represents a successful therapeutic option. In unruptured giant intracranial aneurysms, simultaneous packing of the aneurysm with coils and occlusion of the distal parent artery can have a good outcome.

  18. Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV

    SciTech Connect

    Hagspiel, Klaus D.; Bonatti, Hugo; Sabri, Saher; Arslan, Bulent; Harthun, Nancy L.

    2011-04-15

    Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

  19. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms

    PubMed Central

    Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2016-01-01

    Background and Purpose The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. Materials and Methods In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms. Results While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR), size ratio (SR), dome-to-neck ratio (DN), inflow angle (IA), normalized wall shear stress (NWSS) and percentage of low wall shear stress area (LSA) were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001) and LSA (OR = 1.393, p = 0.041). Conclusions Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms. PMID:26910518

  20. Microsurgical confirmation of perforating arteries arising from the fundus of a posterior communicating artery aneurysm.

    PubMed

    Reynolds, Matthew R; Roland, Jarod L; Kamath, Ashwin A; Cross, DeWitte T; Dacey, Ralph G

    2015-07-01

    Perforating arteries rarely project from the fundus of an aneurysm. We present the case of a 35-year-old woman who was found to have a right posterior communicating artery (PCOM) aneurysm via catheter angiography. Superselective microcatheter angiography revealed that perforating arteries arose from the aneurysm fundus that supplied the anterolateral thalamus. Microsurgical exploration confirmed several small perforating arteries arising from the aneurysm dome as well as an atretic distal PCOM artery. Given the complex anatomy, the lesion was unsuitable for clipping. We propose that this aneurysm represents a developmental variant whereby the proximal PCOM artery becomes atretic and terminates in PCOM perforators. The video can be found here: http://youtu.be/iDcp9fsDjq4.

  1. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    PubMed

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  2. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy.

    PubMed

    Lv, Nan; Yu, Ying; Xu, Jinyu; Karmonik, Christof; Liu, Jianmin; Huang, Qinghai

    2016-08-01

    OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p < 0.05) among the 3 groups. Furthermore, multiple comparisons revealed that these parameters differed significantly between the ONP group and the asymptomatic unruptured group and between the ruptured group and the asymptomatic unruptured group, except for size, which differed significantly only between the ONP group and the asymptomatic unruptured group (p = 0.0005). No morphological or hemodynamic parameters differed between the ONP group and the ruptured group. CONCLUSIONS Unruptured PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.

  3. Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

    PubMed Central

    Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

    2000-01-01

    Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

  4. Spontaneous thrombosis of giant intracranial aneurysm and posterior cerebral artery followed by also spontaneous recanalization

    PubMed Central

    de Aguiar, Guilherme Brasileiro; Pagotto, Mário Vítor Caldeira; Conti, Mario Luiz Marques; Veiga, José Carlos Esteves

    2016-01-01

    Background: Spontaneous complete thrombosis of a giant aneurysm and its parent artery is a rare event. Their spontaneous recanalization is even rarer, with few reports. Case Description: A 17-year-old male patient presenting blurred vision and headache, with a history of seizures, was referred to our service. After further investigation with cranial computed tomography, magnetic resonance imaging (MRI), and cerebral angiography (CAG), it was diagnosed a thrombosed aneurysm of the posterior cerebral artery (PCA) and also complete thrombosis of the PCA. Three years later, he experienced visual worsening. A new MRI scan indicated flow both through the aneurysm and the left PCA, which was further confirmed by CAG. We decided for a noninterventional treatment combined with strict clinical follow-up. The patient continues to present with the previous neurological deficit, without recurrence of headaches. Conclusions: Thrombosis is not the final event in the natural history of giant aneurysms, and partial thrombosis does not preclude the risk of rupture. Thrombosed aneurysms may display additional growth brought about by wall dissections or intramural hemorrhages. Their treatment may be either surgical or involve endovascular procedures such as embolization. Thrombosed giant aneurysms are dynamic and unstable lesions. A noninterventional treatment is feasible, but aneurysmal growth or recanalization may suggest the need for a more active intervention. PMID:26958421

  5. Evolution of Giant P2-Posterior Cerebral Artery Aneurysm over 16 Years: Saccular to Serpentine. A Case Report.

    PubMed

    Sharma, S

    2009-12-14

    Giant intracranial aneurysms account for only about 5% of all intracranial aneurysms. Giant intradural aneurysms are associated with severe natural history, yet remain potentially curable. These aneurysms cause symptoms due to their mass effect, and only 14-35% of cases present with subarachnoid haemorrhage (SAH). The present case report is an imaging evolution of a giant posterior cerebral artery (PCA) aneurysm in a patient who was lost on follow-up from 1992 to 2008 giving insight into the natural history and morphologic evolution of giant serpentine aneurysms. Attempted surgery 16 years previously for a saccular PCA aneurysm produced encephalomalacia and created a more spacious perianeurysmal environment, preventing any mass effect on vital structures in its vicinity. This allowed the patient to have a long symptom-free period and also allowed the aneurysm to follow a morphologic evolution over a long period without causing symptoms which would have called for intervention. This unusual development gave a unique opportunity to study the evolution of a gaint serpentine aneurysm from a saccular aneurysm and also the clinical and morphologic changes in an aneurysm if it can be prevented from producing mass effect. The Coanda effect, or boundary wall effect, has been considered responsible for the development of the serpentine channel in the original globular aneurysm . However many Authors conclude that giant serpentine aneurysms are not derived from saccular aneurysms. PMID:24209407

  6. [Coil embolization of a ruptured posterior cerebral artery aneurysm via the internal carotid artery and a posterior communicating artery: a case report].

    PubMed

    Yamaguchi, Shinya; Ito, Osamu; Imamoto, Naoyuki; Murata, Hideki; Maeda, Yoshihisa; Yuhi, Fumiaki; Natori, Yoshihiro; Matsukado, Koichiro

    2011-02-01

    A posterior cerebral artery aneurysm is a rare condition. Various surgical approaches have to be considered for operating on these aneurysms because the position of the aneurysm and the surrounding structures restrict the operative field and render the operation difficult. Recently, endovascular treatments for posterior cerebral artery aneurysms have been reported to provide a good outcome. We present a case of a ruptured posterior cerebral artery aneurysm treated with coil embolization. We adopted endovascular treatment because a large vein of Labbé was expected to restrict the operative field. The internal carotid artery and a fetal-type posterior communicating artery (PCoA) were chosen as the access route because of P1 hypoplasty, and a coaxial guiding system was used because of the tortuous access route. The aneurysm was suitably embolized using Guglielmi detachable coils (GDCs). In a case of posterior cerebral artery aneurysm, we report the usefulness of endovascular treatment performed through the internal carotid artery and a fetal-type PCoA.

  7. Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization.

    PubMed

    Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

    2015-01-01

    Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment.

  8. Hyperintense Acute Reperfusion Marker on FLAIR in Posterior Circulation Infarction

    PubMed Central

    Wenz, Holger; Böhme, Johannes; Al-Zghloul, Mansour; Groden, Christoph

    2016-01-01

    Purpose In the present study, we aimed to investigate the frequency of blood brain barrier injury in posterior circulation infarction as demonstrated by the hyperintense acute reperfusion marker (HARM) on fluid attenuated inversion recovery images (FLAIR). Methods From a MRI report database we identified patients with posterior circulation infarction who underwent MRI, including perfusion-weighted images (PWI), within 12 hours after onset and follow-up MRI within 24 hours and analyzed diffusion-weighted images (DWI), PWI, FLAIR, and MR angiography (MRA). On FLAIR images, the presence of HARM was noted by using pre-specified criteria (focal enhancement in the subarachnoid space and/or the ventricles). Results Overall 16 patients (median age of patients 68.5 (IQR 55.5–82.75) years) with posterior circulation infarction were included. Of these, 13 (81.3%) demonstrated PCA occlusion, and 3 (18.7%) patients BA occlusion on MRA. Initial DWI demonstrated ischemic lesions in the thalamus (68.8%), splenium (18.8%), hippocampus (75%), occipital lobe (81.3%), mesencephalon (18.8%), pons (18.8%), and cerebellum (50%). On follow-up MRA recanalization was noted in 10 (62.5%) patients. On follow-up FLAIR images, HARM was observed in 8 (50%) patients. In all of these, HARM was detected remote from the acute ischemic lesion. HARM was more frequently observed in patients with vessel recanalization (p = 0.04), minor infarction growth (p = 0.01), and smaller ischemic lesions on follow-up DWI (p = 0.05). Conclusions HARM is a frequent finding in posterior circulation infarction and associated with vessel recanalization, minor infarction growth as well as smaller infarction volumes in the course. Neuroradiologists should be cognizant of the fact that HARM may be present on short interval follow-up FLAIR images in patients with acute ischemic infarction who initially underwent MRI and received intravenous gadolinium-based contrast agents. PMID:27326459

  9. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    PubMed

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2015-06-24

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  10. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

    PubMed Central

    Nanba, Takamasa; Kashimura, Hiroshi; Saura, Hiroaki; Takeda, Masaru

    2016-01-01

    Although posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features. PMID:27365964

  11. Flow-Diverter Stent for the Treatment of a Non-Origin Posterior Inferior Cerebellar Artery Aneurysm

    PubMed Central

    Alokaili, Riyadh Nasser; Ahmed, Muhammad Ejaz

    2014-01-01

    Summary We describe the case of a 44-year old man with a ruptured wide-necked non-origin aneurysm of the posterior inferior cerebellar artery successfully treated with placement of a low porosity stent. To our knowledge, there are no cases in the literature of a non-origin posterior inferior cerebellar artery aneurysm treated with a flow-diverter stent. PMID:25196620

  12. Fatal traumatic aneurysm of the posterior inferior cerebellar artery with delayed rupture.

    PubMed

    Purgina, Bibianna; Milroy, Christopher Mark

    2015-02-01

    Traumatic aneurysms of intracranial arteries are rare, forming less than 1% of all intracranial arteries. They may be associated with penetrating and non-penetrating trauma. Most cases are associated with fracturing of the skull. Rupture of traumatic aneurysms occur in up to 50% of cases and are typically delayed from days to weeks following the initiating trauma. We report a case of a 22-year-old man who was punched to the head. He was rendered unconscious but recovered and had a GCS of 14 on admission. CT scans showed subarachnoid hemorrhage. An initial angiogram was negative but on day 7 following the incident he was noted to have a 1 mm aneurysm of the posterior inferior cerebellar artery on CT angiogram. On day 9 he collapsed and was found to have new subarachnoid hemorrhage and to have a 4.0 mm × 3.7 mm. He did not recover and was declared brain dead on day 12. At autopsy, there was a 4.0 mm aneurysm of the left PICA just after the origin of the artery. Histological examination confirmed the presence of a traumatic false aneurysm in the left PICA. This case study shows sequential radiological imaging with pathologiocal correlation.

  13. Successful Transarterial Embolization of a Posttraumatic Fistula Between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus: A Case Report.

    PubMed

    Jinbo, Yin; Jun, Liu; Kejie, Mou; Zheng, Zhou

    2015-01-01

    Posterior communicating artery (PCoA) aneurysm-cavernous sinus fistulae are an extremely rare complication of head injury . The treatment of PCoA aneurysm-cavernous sinus fistulae has not been well described. A 27-year-old man was admitted with a retroocular bruit and blurred vision of the left eye seven months after a severe head injury. We report the angiographic appearance of a posterior communicating artery (PCoA) aneurysm with a fistula to the cavernous sinus. This injury had been previously misinterpreted to be a PCoA aneurysm by computerized tomographic angiography (CTA). The patient was successfully treated with coils and Onyx of a fistula between the PCoA aneurysm and cavernous sinus. PMID:26442545

  14. [Aneurysm of the anterior inferior cerebellar artery: case report].

    PubMed

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  15. Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery

    PubMed Central

    Shi, Lei; Xu, Kan; Sun, Xiaofeng; Yu, Jinlu

    2016-01-01

    Among the variations of vertebral artery dissecting aneurysms (VDAs), VDAs involving the posterior inferior cerebellar artery (PICA), especially ruptured and high-risk unruptured aneurysms, are the most difficult to treat. Because the PICA is an important structure, serious symptoms may occur after its occlusion. Retained PICAs are prone to re-bleeding because VDAs are difficult to completely occlude. There is therefore confusion regarding the appropriate treatment for VDAs involving the PICA. Here, we used the PubMed database to review recent research concerning VDAs that involve the PICA, and we found that treatments for VDAs involving the PICA include (i) endovascular treatment involving the reconstruction of blood vessels and blood flow, (ii) occluding the aneurysm using an internal coil trapping or an assisted bypass, (iii) inducing reversed blood flow by occluding the proximal VDA or forming an assisted bypass, or (iv) the reconstruction of blood flow via a craniotomy. Although the above methods effectively treat VDAs involving the PICA, each method is associated with both a high degree of risk and specific advantages and disadvantages. The core problem when treating VDAs involving the PICA is to retain the PICA while occluding the aneurysm. Therefore, the method is generally selected on a case-by-case basis according to the characteristics of the aneurysm. In this study, we summarize the various current methods that are used to treat VDAs involving the PICA and provide schematic diagrams as our conclusion. Because there is no special field of research concerning VDAs involving the PICA, these cases are hidden within many multiple-cases studies. Therefore, this study does not review all relevant documents and may have some limitations. Thus, we have focused on the mainstream treatments for VDAs that involve the PICA. PMID:27429591

  16. Delayed Ischemic Stroke after Flow Diversion of Large Posterior Communicating Artery Aneurysm

    PubMed Central

    Kim, Si On; Chung, Yeon Gu; Won, Yu Sam

    2016-01-01

    For securing large, giant, and wide-neck aneurysms, conventional coil embolization has substantial limitations, such as incomplete occlusion, recanalization, and a high recurrence rate. To overcome these limitations, a novel paradigm was suggested and, as a result, flow-diverting device was developed. The flow-diverting device is an innovative and effective technique to allow securing of large, giant, and wide-neck aneurysms. In numerous studies, the flow-diverting device has shown better outcomes than coil embolization. However, the flow-diverting device has also some risks, including rupture of aneurysm, intracerebral hemorrhage, and ischemic stroke. In addition, with more experience, unexpected complications are also reported.5)7) In the present case, we experienced a delayed ischemic stroke at 27 days after endovascular treatment. The patient had multiple aneurysms and, among them, we treated a large posterior communicating artery aneurysm using Pipeline™ Embolization Device. The patient was tolerable for 25 days, but then suddenly presented intermittent right hemiparesis. In the initial diffusion magnetic resonance imaging (MRI), there was no acute lesion; however, in the follow-up MRI, an acute ischemic stroke was found in the territory of anterior choroidal artery which was covered by Pipeline Embolization Device. We suspect that neo-intimal overgrowth or a tiny thrombus have led to this delayed complication. Through our case, we learned that the neurosurgeon should be aware of the possibility of delayed ischemic stroke after flow diversion, as well as, long-term close observation and follow-up angiography are necessary even in the event of no acute complications. PMID:27114962

  17. [Spontaneous occlusion of PICA-involved dissecting aneurysm with development of a collateral channel from the posterior meningeal artery].

    PubMed

    Arai, Atsushi; Miyamoto, Hirohito; Ashida, Noriaki; Kohmura, Eiji

    2012-11-01

    A 53-year-old man suffered severe headache, which continued for three days. No abnormality was shown on CT scan, and a dissecting aneurysm of the right vertebral artery was suspected on MRI. Cerebral angiography revealed a dissection aneurysm of the right vertebral artery involved with the posterior inferior cerebellar artery (PICA) as pearl and string sign. The patient was conservatively managed under careful blood pressure control, and was followed by serial MRI. He presented with Wallenberg syndrome three weeks later. Second angiography revealed the occlusion of the PICA-involved dissecting aneurysm and the lateral medullary segment of the PICA supplied by a newly arising vessel from the right posterior meningeal artery (PMA). For the conservative treatment of a vertebral dissection aneurysm involved with PICA presenting with only pain, observation of the course by MRI was effective, and the PMA could develop as the collateral channel to the PICA territory.

  18. Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

    PubMed Central

    HORIO, Yoshinobu; KATSUTA, Toshiro; SAMURA, Kazuhiro; WAKUTA, Naoki; FUKUDA, Kenji; HIGASHI, Toshio; INOUE, Tooru

    2015-01-01

    There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10–11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach. PMID:26522607

  19. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    PubMed

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  20. Posterior reversible encephalopathy syndrome following hemodynamic treatment of aneurysmal subarachnoid hemorrhage-induced vasospasm.

    PubMed

    Awori, Jonathan; Rajajee, Venkatakrishna; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, B Gregory; Pandey, Aditya S

    2016-04-01

    Posterior reversible encephalopathy syndrome (PRES) is an uncommon but significant complication of hemodynamic therapy after aneurysmal subarachnoid hemorrhage (aSAH)-induced vasospasm. We performed a PubMed literature search for the period January 1999 to January 2015 using the search terms "posterior reversible encephalopathy syndrome", "subarachnoid hemorrhage", "vasospasm", and "hypertensive encephalopathy", and identified nine cases of PRES after aSAH-induced vasospasm in the literature. We also present a 63-year-old man with aSAH complicated by vasospasm treated with hemodynamic augmentation who subsequently developed PRES. Imaging following development of PRES symptoms shows vasogenic edema in the white matter of the parietal and occipital lobes. Age, sex, history of hypertension, and baseline blood pressure were variable among patients in the literature review. In all cases, patients improved both from a radiological and clinical perspective following blood pressure reduction. To summarize, PRES is a rare complication of hemodynamic therapy for vasospasm following aSAH. The literature at the time of writing demonstrates no common pattern with regard to patient demographics, medical history, or mode of treatment for symptomatic vasospasm. Given its sporadic and unpredictable nature, considering PRES in the differential diagnosis is important when addressing neurological decline following hemodynamic treatment of vasospasm related to aSAH. PMID:26755456

  1. Interdisciplinary Clinical Management of High Grade Arteriovenous Malformations and Ruptured Flow-Related Aneurysms in the Posterior Fossa

    PubMed Central

    Mpotsaris, A.; Loehr, C.; Harati, A.; Lohmann, F.; Puchner, M.; Weber, W.

    2010-01-01

    Summary Posterior fossa arteriovenous malformations are rare entities and treatment modalities technically challenging. In recent years new therapeutic options have emerged through microsurgical and endovascular means. Based on a series of six cases we describe combined interdisciplinary treatment strategies and report the outcome in a midterm follow-up interval of 12 months. Clinical case data were collected during acute phase and follow-up including standardized angiographic control intervals during follow-up and assessment of the outcome. Treatment options included endovascular techniques as well as microsurgical techniques. All reported cases had SAH based on ruptured flow-related aneurysms in posterior fossa AVM; three out of six had multiple aneurysms. In one case we observed a de novo formation of two flow-associated distal aneurysms in an interval of ten years. Two patients were treated only endovascularly, one patient only surgically and three patients with combined methods. Five out of six patients had a good outcome (GOS 4 or 5). One died in the acute phase. Infratentorial AVMs are rare but characterized by a high risk of rupture and SAH, especially in conjunction with flow related aneurysms, which are predictors of poor outcome. The anatomic conditions of the posterior fossa may lead quickly to life-threatening complications due to mass effects. The present study indicates that treatment strategies in the acute phase should focus on flow-related aneurysms, followed by an elective AVM embolization and ectomy whenever possible. An experienced interdisciplinary team and the combination of techniques contribute to a reduction of complications and to a better outcome. PMID:21162770

  2. Aneurysms

    MedlinePlus

    ... our e-newsletter! Aging & Health A to Z Aneurysms Basic Facts & Information Fill a balloon too full ... of what can happen when you have an aneurysm. Medically, when an artery “balloons,” or widens, it ...

  3. Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature

    PubMed Central

    Akhtar, Saad; Azeem, Abdul; Jiwani, Amyna; Javed, Gohar

    2016-01-01

    Introduction There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20–24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. Presentation of case We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. Discussion Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. Conclusion The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty. PMID:27017276

  4. Successful treatment of a giant pediatric fusiform basilar trunk aneurysm with surpass flow diverter.

    PubMed

    Kan, Peter; Mokin, Maxim; Puri, Ajit S; Wakhloo, Ajay K

    2016-06-01

    Fusiform aneurysms present a unique challenge to traditional microsurgical and endovascular treatment because of the lack of a discernible neck and the involvement of parent vessel. Flow diversion has increasingly become the treatment of choice for fusiform aneurysms in the anterior circulation, but its results in the posterior circulation are variable. We report successful treatment of a giant fusiform upper basilar trunk aneurysm with the Surpass flow diverter in an adolescent, and discuss the potential advantages of this emerging technology in the treatment of fusiform posterior circulation aneurysms.

  5. Successful treatment of a giant pediatric fusiform basilar trunk aneurysm with surpass flow diverter.

    PubMed

    Kan, Peter; Mokin, Maxim; Puri, Ajit S; Wakhloo, Ajay K

    2015-06-03

    Fusiform aneurysms present a unique challenge to traditional microsurgical and endovascular treatment because of the lack of a discernible neck and the involvement of parent vessel. Flow diversion has increasingly become the treatment of choice for fusiform aneurysms in the anterior circulation, but its results in the posterior circulation are variable. We report successful treatment of a giant fusiform upper basilar trunk aneurysm with the Surpass flow diverter in an adolescent, and discuss the potential advantages of this emerging technology in the treatment of fusiform posterior circulation aneurysms.

  6. Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management

    PubMed Central

    Nouh, Amre; Remke, Jessica; Ruland, Sean

    2014-01-01

    Posterior circulation strokes represent approximately 20% of all ischemic strokes (1, 2). In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anatomical, etiological, and clinical classification of PC strokes, identify diagnostic pitfalls, and overview current therapeutic regimens. PMID:24778625

  7. Successful treatment of a ruptured aneurysm at the vertebral artery-posterior inferior cerebellar artery junction and simultaneous treatment of the stenotic vertebral artery with a single flow-diverting stent: a case report

    PubMed Central

    2014-01-01

    Introduction This is the first report on the simultaneous successful treatment of a large ruptured saccular aneurysm and stenotic parent artery with a single flow-diverting stent. Case presentation We report the case of a 68-year-old Caucasian man with occlusion of the right vertebral artery and a ruptured aneurysm at the junction of the left posterior inferior cerebellar artery-left vertebral artery that was successfully treated by the deployment of a single flow-diverting stent in the stenotic left vertebral artery. Stent deployment was complicated by thrombotic occlusion of the basilar artery, which was successfully reopened. The patient recovered completely, and follow-up angiography at 4 months and 1 year showed patent vertebral artery with gradual shrinkage of the aneurysm. Conclusions This report contributes to the literature on treatment of large ruptured aneurysms localized in stenotic arteries and in areas of the endocranium where a mass of embolic material in the aneurysm (coils) might compromise the circulation in the parent blood vessel or compress vital brain structures. PMID:24886040

  8. Is vertebral artery hypoplasia a predisposing factor for posterior circulation cerebral ischemic events? A comprehensive review.

    PubMed

    Katsanos, Aristeidis H; Kosmidou, Maria; Kyritsis, Athanassios P; Giannopoulos, Sotirios

    2013-01-01

    Vertebral artery hypoplasia is not currently considered an independent risk factor for stroke. Emerging evidence suggest that vertebral artery hypoplasia may contribute to posterior circulation ischemic events, especially when other risk factors coexist. In the present literature review, we present published data to discuss the relationship between a hypoplastic vertebral artery and posterior circulation cerebral ischemia. Despite difficulties and controversies in the accurate definition and prevalence estimation of vertebral artery hypoplasia, ultrasound studies reveal that the reduced blood flow observed ipsilateral to the hypoplastic vertebral artery may result in local cerebral hypoperfusion and subsequent focal neurological symptomatology. That risk of cerebral ischemia is related to the severity of the hypoplasia, suggesting that the smaller of paired arteries are more vulnerable to occlusion. Existing cohort studies further support clinical observations that hypoplastic vertebral artery enhances synergistically the vascular risk for posterior circulation ischemic events and is closely associated with both atherosclerotic and prothrombotic processes.

  9. Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: a case report and literature review.

    PubMed

    Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

    2014-08-01

    Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare.

  10. [A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa].

    PubMed

    Otsuka, Hiroaki; Fukuda, Yuhtaka; Yoshimura, Shouta; Somagawa, Chika; Hiu, Takeshi; Ono, Tomonori; Ushijima, Ryujirou; Toda, Keisuke; Tsutsumi, Keisuke

    2016-06-01

    A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma (ASDH) extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries (IC/PC AN) with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery. Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events. PMID:27270151

  11. Memory impairment caused by cerebral hematoma in the left medial temporal lobe due to ruptured posterior cerebral artery aneurysm

    PubMed Central

    2014-01-01

    Background Cognitive disorders, such as memory disturbances, are often observed following a subarachnoid hemorrhage. We present a very rare case where rupture of a posterior cerebral artery aneurysm caused restricted damage to the hippocampus unilaterally, and caused memory disturbances. Case presentation A 56-year-old, right-handed man, with a formal education history of 16 years and company employees was admitted to our hospital because of a consciousness disturbance. He was diagnosed as having a subarachnoid hemorrhage due to a left posterior cerebral artery dissecting aneurysm, and coil embolization was performed. Subsequently, he had neither motor paresis nor sensory disturbances, but he showed disorientation, and both retrograde and anterograde amnesia. Although immediate recall and remote memory were almost intact, his recent memory was moderately impaired. Both verbal and non-verbal memories were impaired. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed a cerebral hematoma in the left temporal lobe involving the hippocampus and parahippocampal gyrus, and single-photon emission computed tomography (SPECT) demonstrated low perfusion areas in the left medial temporal lobe. Conclusions We suggest that the memory impairment was caused by local tissue destruction of Papez’s circuit in the dominant hemisphere due to the cerebral hematoma. PMID:24602130

  12. The effects of superimposed tilt and lower body negative pressure on anterior and posterior cerebral circulations.

    PubMed

    Tymko, Michael M; Rickards, Caroline A; Skow, Rachel J; Ingram-Cotton, Nathan C; Howatt, Michael K; Day, Trevor A

    2016-09-01

    Steady-state tilt has no effect on cerebrovascular reactivity to increases in the partial pressure of end-tidal carbon dioxide (PETCO2). However, the anterior and posterior cerebral circulations may respond differently to a variety of stimuli that alter central blood volume, including lower body negative pressure (LBNP). Little is known about the superimposed effects of head-up tilt (HUT; decreased central blood volume and intracranial pressure) and head-down tilt (HDT; increased central blood volume and intracranial pressure), and LBNP on cerebral blood flow (CBF) responses. We hypothesized that (a) cerebral blood velocity (CBV; an index of CBF) responses during LBNP would not change with HUT and HDT, and (b) CBV in the anterior cerebral circulation would decrease to a greater extent compared to posterior CBV during LBNP when controlling PETCO2 In 13 male participants, we measured CBV in the anterior (middle cerebral artery, MCAv) and posterior (posterior cerebral artery, PCAv) cerebral circulations using transcranial Doppler ultrasound during LBNP stress (-50 mmHg) in three body positions (45°HUT, supine, 45°HDT). PETCO2 was measured continuously and maintained at constant levels during LBNP through coached breathing. Our main findings were that (a) steady-state tilt had no effect on CBV responses during LBNP in both the MCA (P = 0.077) and PCA (P = 0.583), and (b) despite controlling for PETCO2, both the MCAv and PCAv decreased by the same magnitude during LBNP in HUT (P = 0.348), supine (P = 0.694), and HDT (P = 0.407). Here, we demonstrate that there are no differences in anterior and posterior circulations in response to LBNP in different body positions. PMID:27634108

  13. New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

    PubMed Central

    Wityk, RJ; Pazdera, L; Chang, H-M; Pessin, MS; DeWitt, LD

    2005-01-01

    Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years. PMID:20396470

  14. Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo.

    PubMed

    Wen, Yan; Zhang, Chao; Zhao, Xiao-Feng; Deng, Shi-Zhe; He, Si; Huang, Ling-Hui; Tian, Guang; Meng, Zhi-Hong

    2016-08-01

    Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3-4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo. PMID:27651774

  15. Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo

    PubMed Central

    Wen, Yan; Zhang, Chao; Zhao, Xiao-feng; Deng, Shi-zhe; He, Si; Huang, Ling-hui; Tian, Guang; Meng, Zhi-hong

    2016-01-01

    Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3–4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo. PMID:27651774

  16. Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome. PMID:25272066

  17. Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    D'Souza, Stanlies

    2015-07-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.

  18. Locally aggressive aneurysmal bone cyst of C4 vertebra treated by total en bloc excision and anterior plus posterior cervical instrumentation

    PubMed Central

    Parmar, Himanshu N.; Agrawal, Vinod A.; Shah, Munjal S.; Nanda, Saurav N.

    2015-01-01

    We are presenting a case of cervical (C4) aneurysmal bone cyst in a 13-year-old girl, came to the outpatient department with neck pain and stiffness since 6 months and normal neurology. We did an en bloc excision of locally aggressive tumor through anterior plus posterior approach and stabilization by lateral mass screw fixation and anterior cervical instrumentation. Involvement of several adjacent cervical vertebrae by an aneurysmal bone cyst is rare, and conventional treatment with curettage and bone grafting is most likely to carry a high rate of recurrence and spinal instability. We recommend complete excision of the tumor and instrumentation in a single stage to avoid instability. PMID:26288549

  19. Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction.

    PubMed

    Zhu, Wei; Wang, Ya-Fang; Dong, Xiao-Feng; Feng, Hong-Xuan; Zhao, He-Qing; Liu, Chun-Feng

    2016-09-01

    Vertebral artery dominance (VAD), which is a common congenital variation of vertebral artery, may be associated with an increased risk of cerebral posterior circulation infarction (PCI). The aims of this study were to investigate the correlation of VAD with incidence and laterality of PCI, and oblige the correlation of VAD and basilar artery (BA) curvature. Incidence of separate territory infarction in posterior circulation and incidence of BA curvature were compared between 78 VAD patients and 68 controls. VA dominance, laterality of BA curvature and separate territory infarction, and their directional relationships were observed in VAD group. The incidence of BA curvature in VAD group was significantly higher than that in controls (P = 0.000). 89.7 % (35/39) of patients had an opposite directional relationship between dominant VA and BA curvature. The total incidence of PCI in VAD group was significantly higher than that in controls (P = 0.001). The incidences of posterior inferior cerebellar artery (PICA) and BA territory infarction were both significantly higher than those in controls [11.5 % (9/78) vs. 1.5 % (1/68), P = 0.016; 20.5 % (16/78) vs. 7.4 % (5/68), P = 0.024]. No differences were found in superior cerebellar artery and posterior cerebral artery territory infarction between two groups. 77.8 % (7/9) of PICA infarction were on the opposite side of dominant VA. 75.0 % (12/16) of BA infarction were on the side of dominant VA. The incidence of PCI in BA curvature patients was significantly higher than that in BA straight patients. The incidence of BA curvature is higher in VAD patients, and BA usually bends to the opposite side of dominant VA. The incidence of PCI is higher in VAD patients, especially in PICA infarction and BA infarction patients.

  20. Pathomechanisms and treatment of pediatric aneurysms.

    PubMed

    Krings, Timo; Geibprasert, Sasikhan; terBrugge, Karel G

    2010-10-01

    Pediatric aneurysms are rare diseases distinct from classical adult aneurysms and therefore require different treatment strategies. Apart from saccular aneurysms that are more commonly found in older children, three major pathomechanisms may be encountered: trauma, infection, and dissection. The posterior circulation and more distal locations are more commonly encountered in children compared to adults, and there is an overall male predominance. Clinical findings are not only confined to subarachnoid hemorrhage but may also comprise mass effects, headaches or neurological deficits. In traumatic aneurysms, the skull base and distal anterior communicating artery are commonly affected, and the hemorrhage occurs often delayed (2-4 weeks following the initial trauma). Infectious aneurysms are mostly bacterial in origin, and hemorrhage occurs early after a septic embolic shower. Dissecting aneurysms are the most often encountered aneurysm type in children and can lead to mass effect, hemorrhage, or ischemia depending on the fate of the intramural hematoma. Treatment strategies in pediatric aneurysms include endosaccular coil treatment only for the "classical berry-type" aneurysms; in the other instances, parent vessel occlusion, flow reversal, surgical options, or a combined treatment with bypass and parent vessel occlusion have to be contemplated.

  1. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

    SciTech Connect

    Fang, Yi-Bin Zhao, Kai-Jun Wu, Yi-Na Zhou, Yu Li, Qiang Yang, Peng-Fei Huang, Qing-Hai Zhao, Wen-Yuan Xu, Yi Liu, Jian-Min

    2015-06-15

    PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

  2. Basic flow structure in saccular aneurysms: a flow visualization study.

    PubMed

    Steiger, H J; Poll, A; Liepsch, D; Reulen, H J

    1987-01-01

    Basic flow patterns were investigated in a set of glass aneurysm models by means of flow visualization methods. Dye injection and streaming double refraction were used to visualize flow. The circulation inside lateral aneurysms arising at a 90 degree angle from a straight parent conduit could not be visualized by the dye-injection technique but could be demonstrated by streaming double refraction. The inflow was seen to arise from the downstream lip of the orifice and to project to the dome of the aneurysm. Backflow to the parent conduit took place along the walls of the aneurysm. In aneurysms located at bifurcations, flow characteristics depended on the geometry of the bifurcation and the flow ratio between the branches. Relatively little intra-aneurysmal flow was demonstrated in side branch-related aneurysms arising distal to an asymmetric 90 degrees bifurcation of the type encountered at the junction of the internal carotid and posterior communicating arteries. Stagnation of flow at the neck and little intra-aneurysmal circulation were found with terminal aneurysms of the basilar bifurcation type if the outflow through the branches was symmetric. With asymmetric outflow, however, or if the axis of the aneurysm did not coincide with that of the afferent vessel, an active rotation developed in these aneurysms. The size of the aneurysm had no influence on the basic pattern of intra-aneurysmal circulation. The use of pulsatile perfusion did not significantly alter the basic flow patterns observed with steady flow. Locally disturbed laminar flow was observed in certain models at physiological Reynold's numbers, but there were no signs of fully developed turbulence.

  3. Stent-Assisted Coil Embolization of a Wide-Neck Aneurysm of a Persistent Primitive Hypoglossal Artery

    SciTech Connect

    Baldi, Sebastian Zander, Tobias; Rabellino, Martin; Maynar, Manuel

    2009-03-15

    Persistent primitive hypoglossal artery (PPHA) represents the second most common carotid-vertebrobasilar anastomosis. The association of PPHA with intracranial aneurysms is not unusual. Treatment of aneurysms located on the PPHA itself is challenging due to the increased risk of ischemic complications secondary to the hypoglossal artery often being the sole contributor of flow to the posterior circulation. We report a case of a wide-neck aneurysm in a PPHA successfully treated using a stent-assisted coil embolization technique.

  4. Surgical Flow Alteration for the Treatment of Intracranial Aneurysms That Are Unclippable, Untrappable, and Uncoilable

    PubMed Central

    Lee, Sung Ho; Kwun, Byung Duk; Park, Wonhyoung; Park, Jung Cheol; Roh, Sung Woo

    2015-01-01

    Objective The treatment of complex intracranial aneurysms remains challenging. One approach is the application of surgical flow alteration to treat aneurysms that are neither clippable, trappable, or coilable. The efficacy and limitations of surgical flow alteration have not yet been established. Methods Cases of complex aneurysms treated with surgical flow alteration (proximal occlusion with or without bypass, distal occlusion with or without bypass and bypass only) were included in this retrospective study. Results Among a total of 16 cases, there were 7 giant aneurysms (≥25 mm diameter) and 9 large aneurysms (>10 mm diameter); 15 of 16 aneurysms were unruptured. There were 8 aneurysms located in the anterior circulation, while the other 8 were in the posterior circulation. Aneurysms were treated with proximal occlusion in 10 cases and distal occlusion in 5 cases; in 1 case, the aneurysm occluded spontaneously after bypass without parent artery occlusion. All but 2 cases underwent prior or concurrent bypass surgery. Complete obliteration of the aneurysm at the latest imaging follow-up was shown in 12 of 16 cases (75.0%). Bypass patency was confirmed in 13 of 15 cases (86.7%). Surgery-related morbidity developed in 3 cases (18.8%, Glasgow outcome scale of 4) and all were perforator infarctions. There were no mortalities. Conclusion Surgical flow alteration resulted in a high rate of aneurysmal obliteration with acceptable morbidity. Although several limitations remained, it could represent an alternative method for treating complex aneurysms. PMID:26819686

  5. New England Medical Center Posterior Circulation Stroke Registry: I. Methods, Data Base, Distribution of Brain Lesions, Stroke Mechanisms, and Outcomes

    PubMed Central

    Chung, C-S; Wityk, RJ; Glass, TA; Tapia, J; Pazdera, L; Chang, H-M; Dashe, JF; Chaves, CJ; Vemmos, K; Leary, M; Dewitt, LD; Pessin, MS

    2005-01-01

    Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potential cardiac and arterial sources). In 32%, large artery occlusive lesions caused hemodynamic brain infarction. Stroke mechanisms in the posterior and anterior circulation are very similar. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes), while the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Infarcts that included the distal territory were twice as common as those that included the proximal or middle territories. Most distal territory infarcts were attributable to embolism. Thirty day mortality was low (3.6%). Embolic stroke mechanism, distal territory location, and basilar artery occlusive disease conveyed the worst prognosis. PMID:20396469

  6. Increased Arterial Diameters in the Posterior Cerebral Circulation in Men with Fabry Disease

    PubMed Central

    Üçeyler, Nurcan; Homola, György A.; Guerrero González, Hans; Kramer, Daniela; Wanner, Christoph; Weidemann, Frank; Solymosi, László; Sommer, Claudia

    2014-01-01

    A high load of white matter lesions and enlarged basilar arteries have been shown in selected patients with Fabry disease, a disorder associated with an increased stroke risk. We studied a large cohort of patients with Fabry disease to differentially investigate white matter lesion load and cerebral artery diameters. We retrospectively analyzed cranial magnetic resonance imaging scans of 87 consecutive Fabry patients, 20 patients with ischemic stroke, and 36 controls. We determined the white matter lesion load applying the Fazekas score on fluid-attenuated inversion recovery sequences and measured the diameters of cerebral arteries on 3D-reconstructions of the time-of-flight-MR-angiography scans. Data of different Fabry patient subgroups (males – females; normal – impaired renal function) were compared with data of patients with stroke and controls. A history of stroke or transient ischemic attacks was present in 4/30 males (13%) and 5/57 (9%) females with Fabry disease, all in the anterior circulation. Only one man with Fabry disease showed confluent cerebral white matter lesions in the Fazekas score assessment (1%). Male Fabry patients had a larger basilar artery (p<0.01) and posterior cerebral artery diameter (p<0.05) compared to male controls. This was independent of disease severity as measured by renal function and did not lead to changes in arterial blood flow properties. A basilar artery diameter of >3.2 mm distinguished between men with Fabry disease and controls (sensitivity: 87%, specificity: 86%, p<0.001), but not from stroke patients. Enlarged arterial diameters of the posterior circulation are present only in men with Fabry disease independent of disease severity. PMID:24475221

  7. Increased arterial diameters in the posterior cerebral circulation in men with Fabry disease.

    PubMed

    Uçeyler, Nurcan; Homola, György A; Guerrero González, Hans; Kramer, Daniela; Wanner, Christoph; Weidemann, Frank; Solymosi, László; Sommer, Claudia

    2014-01-01

    A high load of white matter lesions and enlarged basilar arteries have been shown in selected patients with Fabry disease, a disorder associated with an increased stroke risk. We studied a large cohort of patients with Fabry disease to differentially investigate white matter lesion load and cerebral artery diameters. We retrospectively analyzed cranial magnetic resonance imaging scans of 87 consecutive Fabry patients, 20 patients with ischemic stroke, and 36 controls. We determined the white matter lesion load applying the Fazekas score on fluid-attenuated inversion recovery sequences and measured the diameters of cerebral arteries on 3D-reconstructions of the time-of-flight-MR-angiography scans. Data of different Fabry patient subgroups (males-females; normal-impaired renal function) were compared with data of patients with stroke and controls. A history of stroke or transient ischemic attacks was present in 4/30 males (13%) and 5/57 (9%) females with Fabry disease, all in the anterior circulation. Only one man with Fabry disease showed confluent cerebral white matter lesions in the Fazekas score assessment (1%). Male Fabry patients had a larger basilar artery (p<0.01) and posterior cerebral artery diameter (p<0.05) compared to male controls. This was independent of disease severity as measured by renal function and did not lead to changes in arterial blood flow properties. A basilar artery diameter of >3.2 mm distinguished between men with Fabry disease and controls (sensitivity: 87%, specificity: 86%, p<0.001), but not from stroke patients. Enlarged arterial diameters of the posterior circulation are present only in men with Fabry disease independent of disease severity.

  8. Successful Transarterial Guglielmi Detachable Coil Embolization of Post-Traumatic Fistula between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus

    PubMed Central

    Chen, Y.; Jiang, D-Y.; Tan, H-Q.; Wang, L-H.; Chen, X-Y.; Sun, J-H.

    2009-01-01

    Summary We describe a case of a post-traumatic posterior communicating artery (PCoA) aneurysmcavernous sinus fistula, which is an extremely rare complication of craniocerebral trauma, successfully treated with endosaccular coil embolization via transarterial route. Endosaccular embolization with Guglielmi detachable coils via transarterial route appears to be a feasible, effective and minimally invasive option for the treatment of post-traumatic fistula between the PCoA aneurysm with a small ostia and the cavernous sinus in the subacute phase. PMID:20465883

  9. Is the circulating plasma volume sufficiently maintained? Fluid management of an aneurysmal subarachnoid hemorrhage in the acute phase.

    PubMed

    Mori, Tatsuro; Katayama, Yoichi; Igarashi, Takahiro; Moro, Nobuhiro; Kojima, Jun; Hirayama, Teruyasu

    2012-12-01

    Cerebral vasospasm is a well-known cause of mortality and morbidity following aneurysmal subarachnoid hemorrhage (SAH). Prevention of symptomatic cerebral vasospasm is the basic management after SAH. Numerous pharmaceutical therapies and endovascular treatments are available against cerebral vasospasm, but none of them have so far proven to improve the outcome. We have focused on maintaining the circulation volume in order to prevent cerebral vasospasm. But to maintain the central venous pressure, huge infusion volume was required, and hyponatremia was frequently observed due to natriuresis and osmotic diuresis. Excessive natriuresis and diuresis cannot be managed through sodium and water replacement, since sodium replacement induces further natriuresis and diuresis (desalination), and water replacement induces hyponatremia. We therefore administered fludrocortisone and hydrocortisone to inhibit excessive natriuresis and diuresis. The efficacy of sodium reabsorption therapy is extremely high to maintain the circulation volume that might have a therapeutic effect to prevent cerebral vasospasm. In this article, we review our institution's experience regarding the management of patients with aneurysmal SAH and also discuss the importance of water and sodium balance when managing such patients.

  10. Embolisation of recently ruptured intracranial aneurysms.

    PubMed Central

    Byrne, J V; Molyneux, A J; Brennan, R P; Renowden, S A

    1995-01-01

    Patients with subarachnoid haemorrhage due to the rupture of aneurysms unsuitable for craniotomy and clipping have been treated by coil embolisation within three weeks. Sixty nine of 75 consecutive patients were successfully treated. Procedure related complications occurred in 10 patients, resulting in permanent neurological deficits in three and one death (4.8%). The Glasgow outcome scores at six weeks were 53 grade 1, seven grade 2, four grade 3, and five grade 5. These results are comparable with surgical series despite a high proportion of aneurysms in the posterior cerebral circulation. Images PMID:7500100

  11. Aneurysms of the medullary segments of the posterior-inferior cerebellar artery: considerations on treatment strategy and clinical outcome.

    PubMed

    Bacigaluppi, Susanna; Bergui, Mauro; Crobeddu, Emanuela; Garbossa, Diego; Ducati, Alessandro; Fontanella, Marco

    2013-04-01

    Proximal aneurysms of the medullary postero-inferior cerebellar artery (PICA) tract are peculiar due to critical anatomical location, small size and tortuosity of the parent vessel, close origin to brainstem perforators, and fragility of the sac wall. Moreover, most patients present after bleeding, increasing the challenges. Aim of this study is to evaluate the treatment modality and outcome of these patients during the last decade at the University Clinic of Torino. Databases of the Neurosurgical and Neuroradiological Department of the University of Torino were analyzed to retrieve patients treated for aneurysms of the medullary PICA tract. Charts and neuroradiological documentation were revised to complete the database. Of 621 patients treated for an intracranial aneurysm, 23 had PICA aneurysm, 18 located at the medullary tract. Only two were unruptured and 16 were ruptured aneurysms. Sixteen underwent endovascular treatment and two underwent surgery. In six cases the aneurysm was cured by parent vessel occlusion. At 6 months follow-up, the Glasgow outcome scale was high (5 and 4) in 16 patients; two patients had died in the acute phase, for reasons unrelated to the procedure. If not adequately compensated, parent vessel occlusion associates with high risks of ischemia and related brain swelling. In the present series sufficient collateral flow contributed to a good tolerance toward occlusion in all cases. Despite the small size of the present series, most treated cases presented a good outcome. Nevertheless, distal revascularization of the occluded artery would be indicated where collateral flow is insufficient.

  12. [Fusion imaging of 3D MR cisternography/angiography for differential diagnosis of internal carotid-posterior communicating artery aneurysms and infundibular dilations].

    PubMed

    Satoh, Toru; Sasahara, Wataru; Omi, Megumi; Ohsako, Chika

    2006-05-01

    By using a fusion imaging of three-dimensional (3D) magnetic resonance cisternography (MRC) and coregistered magnetic resonance angiography (MRA), protrusions at the bifurcation of the internal carotid-posterior communication artery, detected by MRA, were investigated to differentiate between the infundibular dilations and aneurysms. The MRA, obtained by the 3D time-of-flight sequence, showed the flow-related arterial structures by means of an inflow effect mainly induced by the peak systolic flow velocity. The MRC, obtained by 3D fast spin-echo sequence, depicted the contours of the vascular structures within the cisternal space in contrast to the surrounding cerebrospinal fluid. Fusion images of 3D MRC/MRA showed the anatomy of protrusions from the different viewpoints with flow-related intraluminal images (MRA) in conjunction with outer-wall configuration images of the vascular structures (MRC). This imaging technique may be useful to differentiate the infundibular dilations from the internal carotid-posterior communicating artery aneurysms.

  13. Experience of Y-Configured Stents for Small Basilar Tip Aneurysms

    PubMed Central

    Cho, Chun-Sung; Kim, Young-Joon; Kim, Jin Kyung; Kim, Young Jin; Lee, Sang Koo; Cho, Maeng Ki

    2007-01-01

    Summary Among posterior circulation aneurysms, basilar tip aneurysm is the most difficult to treat. Because of their deep location in front of the brain-stem and their intimate relationship to perforating vessels, morbidity and mortality rates associated with direct exposure used to be daunting. Complex intracranial aneurysms are not uncommonly encountered in cerebrovascular practice. Often their complexity can render standard treatment either impossible or exceedingly hazardous. Although endovascular therapy is an available alternative to surgical clipping, it is not without risks. The Neuroform stent represents a significant advance in the endovascular treatment of intracranial aneurysms. The Y-configured reconstruction method of the Neuroform stent may represent a variable therapeutic option especially in the case of terminal type including bifurcation aneurysms. We report the results of our experience in two small basilar tip aneurysms using stent-assisted coiling. PMID:20566128

  14. The Use of Flow Diversion for the Treatment of Intracranial Aneurysms: Expansion of Indications

    PubMed Central

    Brouillard, Adam M; Sun, Xingwen; Siddiqui, Adnan H

    2016-01-01

    Flow diversion is a novel concept for treating anatomically challenging intracranial aneurysms and has gained increasing acceptance. Flow diverter stents, such as the Pipeline Embolization Device (PED) (ev3-Covidien, Irvine, CA, USA), are approved for treating unruptured large and giant aneurysms from the internal carotid artery between the superior hypophyseal and cavernous segments. However, technological advances and recent clinical results suggest that flow diversion can be safely and effectively used in treating ruptured aneurysms, posterior circulation aneurysms, and distal anterior circulation aneurysms. In this brief review, we aim to investigate the recent evidence on the utilization of PEDs in these controversial vascular territories and to discuss whether the indications for flow diversion can be expanded.   PMID:26973807

  15. Intravenous thrombolysis is more safe and effective for posterior circulation stroke

    PubMed Central

    Tong, Xu; Liao, Xiaoling; Pan, Yuesong; Cao, Yibin; Wang, Chunjuan; Liu, Liping; Zheng, Huaguang; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Wang, Yongjun

    2016-01-01

    Abstract We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) with alteplase for anterior circulation stroke (ACS) and posterior circulation stroke (PCS). From a large multicenter prospective registry—the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database—all patients who received IVT within 4.5 hours after stroke onset was reviewed. According to the clinical presentations and imaging findings, the eligible patients were divided into ACS and PCS groups. The safety and efficacy outcome measures included post-IVT symptomatic intracranial hemorrhage (sICH), parenchymal hematoma, and all intracranial hemorrhage (aICH) within 7 days, mortality within 90 days, excellent recovery (modified Rankin Scale 0–1), and functional independence (modified Rankin Scale 0–2) at 90 days. For comparing the outcomes between both groups, the odds ratios (ORs) with 95% confidence intervals (CIs) and the adjusted ORs with 95% CIs were analyzed by univariate and multivariate logistic regression models. Of 953 patients enrolled, 829 patients had ACS and 124 had PCS. The patients with PCS had less often atrial fibrillation (11.3% vs 19.8%; P = 0.02), higher blood glucose level (8.31 vs 7.63 mmol/L; P = 0.02), and more white blood cell counts (8.79 vs 7.75 × 109/L; P = 0.001) than those with ACS. After adjustment for the potential confounders, multivariate logistic analysis showed that PCS patients had not only lower rates of sICH (3.2% vs 7.7%; OR 0.28, 95% CI 0.09–0.90), parenchymal hematoma (1.6% vs 9.2%; OR 0.13, 95% CI 0.03–0.57), and aICH (8.1% vs 20.4%; OR 0.26, 95% CI 0.12–0.54), but also higher proportions of excellent recovery (55.7% vs 41.6%; OR 2.27, 95% CI 1.42–3.61) and functional independence (63.9% vs 53.0%; OR 2.33, 95% CI 1.40–3.89) compared with ACS patients. However, there was no significant difference in the occurrence of mortality (OR 0.86, 95% CI 0.39–1.91) between both groups in the

  16. A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions

    PubMed Central

    Onan, Hasan Bilen; Balli, Huseyin Tugsan; Cetinalp, Nuri Eralp

    2016-01-01

    The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone. PMID:27668108

  17. Comparison between Solitaire™ AB and Enterprise stent-assisted coiling for intracranial aneurysms

    PubMed Central

    YE, HUA-WEI; LIU, YA-QI; WANG, QIU-JING; ZHENG, TAO; CUI, XU-BO; GAO, YU-YUAN; LAI, LING-FENG; ZHANG, XIN; LI, XI-FENG; SU, SHI-XING; HE, XU-YING; DUAN, CHUAN-ZHI

    2015-01-01

    The aim of the present study was to analyze the feasibility, rate of procedure-related complications and midterm angiographic follow-up outcomes using the Enterprise (EP) and Solitaire™ AB (ST) stents in the stent-assisted coiling of intracranial aneurysms. In total, 81 patients with 90 aneurysms were included in the study, with the aim to treat 43 aneurysms with the EP stent (47.8%) and 47 aneurysms with the ST stent (52.2%). The 90 aneurysms were successfully stented and subsequently coiled; however, in four patients undergoing treatment with the EP stent, the stent was not navigable; thus, treatment with the ST stent was employed (EP, n=39, 43.3%; ST, n=51, 56.7%). Of the 90 aneurysms, 44 cases were ruptured aneurysms, with 74 located in the anterior circulation and 16 located in the posterior circulation. The stenting success rate of the ST stent was significantly higher compared with the EP stent. However, no statistically significant differences were observed with regard to the packing density, complete occlusion, progressive occlusion, recurrence rate, procedure-related complications, in-stent stenosis and stent migration rates between the two groups. In conclusion, the two common medical devices used for intracranial aneurysms are relatively safe and effective for the treatment of intracranial aneurysms. However, due to the higher stenting success rate of the ST stent, this medical devise was demonstrated to be more flexible and feasible compared with the EP stent. PMID:26170926

  18. A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions

    PubMed Central

    Onan, Hasan Bilen; Balli, Huseyin Tugsan; Cetinalp, Nuri Eralp

    2016-01-01

    The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone.

  19. [Dissecting aneurysm of the anterior cerebral artery with later development of collateral circulation: a case report].

    PubMed

    Nakanishi, K; Uchiyama, T; Akai, F; Yamada, Y; Yugami, H; Tuji, K; Taneda, M

    2001-08-01

    Intracranial dissecting aneurysm (DA) is much less frequent than berry aneurysm. Such dissection involves mostly the vertebral and basilar arteries, followed by the internal carotid and middle cerebral arteries. DA of the anterior cerebral artery (ACA) is relatively rare and little is known about its natural Development. Only 23 cases have been reported previously. Our present patient, a 44-year-old man, suddenly developed paresis of the left leg while bathing. Diffusion magnetic resonance imaging indicated an area of high signal intensity in the territory of the ACA. Angiography on day 3 following onset showed a DA involving the left A2 segment. Antiplatelet therapy was administered. Further luminal narrowing in the lesion was demonstrated by repeat angiography on day 17. Occlusion of the distal A2 segment was demonstrated together with sufficient collateral supply on day 41. Symptoms resolved completely. DA of the ACA usually presents with ischemic attacks. Its etiology remains uncertain, and its natural course is unclear. Surgical intervention is recommended for patients with intracranial hemorrhage, while non surgical therapies have achieved good outcomes in ischemic cases.

  20. Very late in-stent thrombosis 9 years after double stent treatment of fusiform basilar artery aneurysm.

    PubMed

    Juszkat, Robert; Stanislawska, Katarzyna; Wasik, Norbert; Jankowski, Roman; Liebert, Włodzimierz

    2015-06-01

    Endovascular treatment seems to be the best approach to posterior circulation fusiform aneurysms. Double stent techniques are frequently used to occlude basilar artery dilations. Unfortunately, there is a limited number of studies that have followed up with patients over prolonged periods of time in order to evaluate delayed complications, such as stenosis, thrombosis or migration of stents. We present an unusual case of in-stent thrombosis 9 years after basilar artery aneurysm treatment to caution about complications associated with double stent implantation.

  1. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

    SciTech Connect

    Laborda, Alicia; Tejero, Carlos; Fredes, Arturo; Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Angel de

    2013-06-15

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  2. Case Report: A Troublesome Ophthalmic Artery Aneurysm

    PubMed Central

    Meling, T. R.; Sorteberg, W.; Bakke, S. J.; Jacobsen, E. A.; Lane, P.; Vajkoczy, P.

    2014-01-01

    Objective and Importance When treating large unruptured ophthalmic artery (OA) aneurysms causing progressive blindness, surgical clipping is still the preferred method because aneurysm sac decompression may relieve optic nerve compression. However, endovascular treatment of OA aneurysms has made important progress with the introduction of stents. Although this development is welcomed, it also makes the choice of treatment strategy less straightforward than in the past, with the potential of missteps. Clinical Presentation A 56-year-old woman presented with a long history of progressive unilateral visual loss and magnetic resonance imaging showing a 20-mm left-sided OA aneurysm. Intervention Because of her long history of very poor visual acuity, we considered her left eye to be irredeemable and opted for endovascular therapy. The OA aneurysms was treated with stent and coils but continued to grow, threatening the contralateral eye. Because she failed internal carotid artery (ICA) balloon test occlusion, we performed a high-flow extracranial-intracranial bypass with proximal ICA occlusion in the neck. However, aneurysm growth continued due to persistent circulation through reversed blood flow in distal ICA down to the OA and the cavernous portion of the ICA. Due to progressive loss of her right eye vision, we surgically occluded the ICA proximal to the posterior communicating artery and excised the coiled, now giant, OA aneurysm. This improved her right eye vision, but her left eye was permanently blind. Conclusion This case report illustrates complications of the endovascular and surgical treatment of a large unruptured OA aneurysm. PMID:25485220

  3. Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries.

    PubMed

    Kim, Chulho; Sohn, Jong-Hee; Jang, Min Uk; Hong, Sung-Kwang; Lee, Joong-Seob; Kim, Hyung-Jong; Choi, Hui-Chul; Lee, Jun Ho

    2016-01-01

    The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.

  4. Unilateral moyamoya syndrome involving the ipsilateral anterior and posterior circulation associated with paroxysmal nocturnal hemoglobinuria.

    PubMed

    Mugikura, Shunji; Higano, Shuichi; Fujimura, Miki; Shimizu, Hiroaki; Takahashi, Shoki

    2010-04-01

    Moyamoya refers to a phenomenon of stenoocclusive changes at or around the terminal part of the internal carotid artery (ICA). Moyamoya vessels develop in patients with (moyamoya syndrome) or without (moyamoya disease) various underlying diseases or conditions. Recent evidence shows that stenoocclusive lesions tend to involve the ipsilateral ICA system and posterior cerebral artery (PCA) predominantly in moyamoya disease. A 53-year-old Japanese woman with paroxysmal nocturnal hemoglobinuria presented with cerebral infarction from stenoocclusive involvement in the ipsilateral ICA and PCA associated with moyamoya vessels; she had no contralateral vascular lesion. Although predominant involvement of the ipsilateral ICA and PCA was associated with underlying disease (moyamoya syndrome) in the present case, it is a characteristic finding of moyamoya disease. We discuss the possible pathogenesis of the vascular changes of this case.

  5. Changes of size and shape of small, unruptured intracranial aneurysms in repeated computed tomography angiography studies

    PubMed Central

    Kunert, Przemysław; Jaworski, Maciej; Rosiak, Grzegorz; Marchel, Andrzej; Rowiński, Olgierd

    2015-01-01

    Introduction Unruptured intracranial aneurysms (UIAs) are frequently detected in noninvasive imaging studies such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA). If small, UIAs are observed in these modalities in order to detect growth or shape change, but there are many questions about proper protocol of the follow-up. Aim To assess changes of small (< 7 mm) UIAs dome size and shape in repeated CTA studies as predictors of growth and rupture. Material and methods One hundred and ten UIAs (10 posterior circulation) in 70 patients (55 women) were observed, with a cumulative observation time of 333.32 years. Aneurysms’ dome and neck perpendicular dimensions were measured in the first and the last CTA study at least twice with the developed application. Confidence intervals (CI) for measurements and dome shape parameters were calculated. For aneurysms ruptured during follow-up intermediate studies were analyzed. Patients’ clinical information was recorded. The aneurysm growth detection algorithm integrated CI and spatial resolution of the CT scanner. Results Twenty-three aneurysms increased in volume, 10 in height and 14 in dome width. Volume increased in 90% of cases of height and 93% of width increase. Posterior circulation aneurysms grew faster than anterior ones (p < 0.003), but calculated time to significant size increase (eT) did not differ between the groups due to higher CI in the posterior circulation. Analysis of eT with Kaplan-Meier curves showed that 75% of growing aneurysms could be detected in the first 3 years of observation. During the follow-up 3 aneurysms bled, and they grew faster than other growing aneurysms. Two of the bleeding aneurysms formed daughter sacs. Conclusions Dome volume assessment is superior to single dimension assessment in aneurysm growth detection. Confidence intervals assessment helps to avoid overestimation of growth. Seventy-five percent of growing aneurysms could be detected in the first 3

  6. Coil Embolization for Intracranial Aneurysms

    PubMed Central

    2006-01-01

    Executive Summary Objective To determine the effectiveness and cost-effectiveness of coil embolization compared with surgical clipping to treat intracranial aneurysms. The Technology Endovascular coil embolization is a percutaneous approach to treat an intracranial aneurysm from within the blood vessel without the need of a craniotomy. In this procedure, a microcatheter is inserted into the femoral artery near the groin and navigated to the site of the aneurysm. Small helical platinum coils are deployed through the microcatheter to fill the aneurysm, and prevent it from further expansion and rupture. Health Canada has approved numerous types of coils and coil delivery systems to treat intracranial aneurysms. The most favoured are controlled detachable coils. Coil embolization may be used with other adjunct endovascular devices such as stents and balloons. Background Intracranial Aneurysms Intracranial aneurysms are the dilation or ballooning of part of a blood vessel in the brain. Intracranial aneurysms range in size from small (<12 mm in diameter) to large (12–25 mm), and to giant (>25 mm). There are 3 main types of aneurysms. Fusiform aneurysms involve the entire circumference of the artery; saccular aneurysms have outpouchings; and dissecting aneurysms have tears in the arterial wall. Berry aneurysms are saccular aneurysms with well-defined necks. Intracranial aneurysms may occur in any blood vessel of the brain; however, they are most commonly found at the branch points of large arteries that form the circle of Willis at the base of the brain. In 85% to 95% of patients, they are found in the anterior circulation. Aneurysms in the posterior circulation are less frequent, and are more difficult to treat surgically due to inaccessibility. Most intracranial aneurysms are small and asymptomatic. Large aneurysms may have a mass effect, causing compression on the brain and cranial nerves and neurological deficits. When an intracranial aneurysm ruptures and bleeds

  7. Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

    PubMed Central

    Galzio, Renato J.; Di Cola, Francesco; Raysi Dehcordi, Soheila; Ricci, Alessandro; De Paulis, Danilo

    2013-01-01

    Background: The endovascular techniques has widely changed the treatment of intracranial aneurysms. However surgery still represent the best therapeutic option in case of broad-based and complex lesions. The combined use of endoscopic and microsurgical techniques (EAM) may improve surgical results. Objective: The purpose of our study is to evaluate the advantages and limits of EAM for intracranial aneurysms. Methods: Between January 2002 and December 2012, 173 patients, harboring 206 aneurysms were surgically treated in our department with the EAM technique. One hundred and fifty-seven aneurysms were located in the anterior circulation and 49 were in the posterior circulation. Standard tailored approaches, based on skull base surgery principles, were chosen. The use of the endoscope included three steps: initial inspection, true operative time, and final inspection. For each procedure, an intraoperative video and an evaluation schedule were prepared, to report surgeons’ opinions about the technique itself. In the first cases, we always used the endoscope during surgical procedures in order to get an adequate surgical training. Afterwards we became aware in selecting cases in which to apply the endoscopy, as we started to become familiar with its advantages and limits. Results: After clipping, all patients were undergone postoperative cerebral angiography. No surgical mortality related to EAM were observed. Complications directly related to endoscopic procedures were rare. Conclusion: Our retrospective study suggests that endoscopic efficacy for aneurysms is only scarcely influenced by the preoperative clinical condition (Hunt–Hess grade), surgical timing, presence of blood in the cisterns (Fisher grade) and/or hydrocephalus. However the most important factors contributing to the efficacy of EAM are determined by the anatomical locations and sizes of the lesions. Furthermore, the advantages are especially evident using dedicated scopes and holders, after an

  8. Moyamoya disease associated with arteriovenous malformation and anterior communicating artery aneurysm: A case report and literature review

    PubMed Central

    YU, JINLU; YUAN, YONGJIE; ZHANG, DUODUO; XU, KAN

    2016-01-01

    Moyamoya disease (MMD) can be associated with an aneurysm or arteriovenous malformation (AVM). However, no case of MMD simultaneously associated with both intracranial aneurysm and AVM has been previously reported. The present study reports the case of a patient with MMD simultaneously associated with both aneurysm and AVM. The patient was a 46-year-old woman presenting with a subarachnoid hemorrhage whose imaging diagnosis of MMD was associated with an aneurysm and AVM. The aneurysm was located in the anterior communicating artery, which was similar to a berry aneurysm caused by hemodynamics. The AVM was located in the posterior circulation. Beyond the presentation of the posterior cerebral artery, the appearance of an artery supplying blood from the middle cerebral artery supported the view that the AVM was congenital and unruptured. Conservative treatment was provided and examination of the patient at follow-up showed good recovery. In addition to the case report, the present study also reviewed the relevant literature in order to compile information on MMD associated with both an aneurysm and AVM. PMID:27347048

  9. Cerebral Aneurysms

    MedlinePlus

    ... Enhancing Diversity Find People About NINDS NINDS Cerebral Aneurysms Information Page Synonym(s): Aneurysm, Brain Aneurysm Condensed from ... Español Additional resources from MedlinePlus What is Cerebral Aneurysms? A cerebral aneurysm is a weak or thin ...

  10. Aneurysm Repair

    MedlinePlus

    ... to other parts of the body (the aorta). Aortic aneurysms can occur in the area below the stomach ( ... or in the chest (thoracic aneurysms). An abdominal aortic aneurysm (AAA) is usually located below the kidneys. In ...

  11. Very late in-stent thrombosis 9 years after double stent treatment of fusiform basilar artery aneurysm

    PubMed Central

    Juszkat, Robert; Stanislawska, Katarzyna; Jankowski, Roman; Liebert, Włodzimierz

    2015-01-01

    Endovascular treatment seems to be the best approach to posterior circulation fusiform aneurysms. Double stent techniques are frequently used to occlude basilar artery dilations. Unfortunately, there is a limited number of studies that have followed up with patients over prolonged periods of time in order to evaluate delayed complications, such as stenosis, thrombosis or migration of stents. We present an unusual case of in-stent thrombosis 9 years after basilar artery aneurysm treatment to caution about complications associated with double stent implantation. PMID:25964437

  12. Spontaneous thrombosis in giant aneurysm of the anterior communicating artery complex in pediatric age: five-year follow-up.

    PubMed

    Gonçalves, Vítor M; Cristino, N; Cunha E Sá, M

    2014-01-01

    Intracranial aneurysms are rare in the pediatric population, especially in infancy, representing less than 1% of all aneurysms. In this age group, they are more frequent at the carotid bifurcation and in the posterior circulation, with a greater number of giant aneurysms and spontaneous aneurysm thrombosis when compared with the adults. They are life-threatening, and, therefore, early investigation, characterization of the lesion, and treatment are essential. The appropriate management depends on the child's condition, aneurysm characteristics, and the experience of a multidisciplinary team. Noninvasive and radiation-free imagiological studies play an important role in the diagnosis and follow-up of these young patients. We present the case of a 3-month-old boy with an intracranial hemorrhage secondary to the rupture of a giant aneurysm of the anterior communicating artery complex, with spontaneous thrombosis, which is a rare situation due to its location. A conservative approach was assumed and noninvasive evolutive imagiological studies revealed a reduction in the thrombosed aneurysm size and no signs of recanalization. The child recovered to his baseline neurological condition and has had no rehemorrhage until 5 years of follow-up.

  13. The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center.

    PubMed

    Natarajan, Sabareesh K; Lin, Ning; Sonig, Ashish; Rai, Ansaar T; Carpenter, Jeffrey S; Levy, Elad I; Siddiqui, Adnan H

    2016-07-01

    OBJECT Pessimism exists regarding flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures. The authors report the results of patients who underwent Pipeline Embolization Device (PED) flow diversion using novel strategies for treatment of fusiform posterior circulation aneurysms, and compare these results with those from previously reported series. METHODS The authors conducted a retrospective review of data from consecutive patients with fusiform vertebrobasilar artery aneurysms treated with the PED. RESULTS This review resulted in the identification of 12 such patients (mean [± SD] age 55.1 ± 14.1 years). Eleven patients had symptoms; 1 had a dissecting aneurysm identified on imaging for neck pain. The average aneurysm size was 13.25 ± 4.5 mm. None of the aneurysms were ruptured or previously treated. The average clinical follow-up duration was 22.1 ± 10.7 months and radiological follow-up was 14.5 ± 11.1 months from the index PED treatment. One patient suffered a perforator stroke and had a modified Rankin Scale (mRS) score of 4 at last follow-up. Another patient had a retained stent pusher requiring retrieval via surgical cut-down but recovered to an mRS score of 0 at last follow-up. Eleven (91.7%) of 12 patients recovered to an mRS score of 0 or 1. Two patients had aneurysmal remnants at 7 and 10 months, respectively, after the index PED, which were retreated with PEDs. At last follow-up, all 12 aneurysms were occluded and PEDs were patent. The minimum follow-up duration was 12 months from the index PED treatment; no patient experienced delayed hemorrhage, stroke, or in-stent stenosis. CONCLUSIONS Flow diversion with selective adjunctive techniques is evolving to become a safer treatment option for posterior circulation aneurysms. This is the longest clinical follow-up duration reported for a single-center experience of flow-diversion treatment of these aneurysms.

  14. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    SciTech Connect

    Stefanczyk, Ludomir; Elgalal, Marcin; Papiewski, Andrzej; Szubert, Wojciech; Szopinski, Piotr

    2013-06-15

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  15. Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort.

    PubMed

    Jaja, Blessing N R; Lingsma, Hester; Steyerberg, Ewout W; Schweizer, Tom A; Thorpe, Kevin E; Macdonald, R Loch

    2016-06-01

    OBJECT Neuroimaging characteristics of ruptured aneurysms are important to guide treatment selection, and they have been studied for their value as outcome predictors following aneurysmal subarachnoid hemorrhage (SAH). Despite multiple studies, the prognostic value of aneurysm diameter, location, and extravasated SAH clot on computed tomography scan remains debatable. The authors aimed to more precisely ascertain the relation of these factors to outcome. METHODS The data sets of studies included in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository were analyzed including data on ruptured aneurysm location and diameter (7 studies, n = 9125) and on subarachnoid clot graded on the Fisher scale (8 studies; n = 9452) for the relation to outcome on the Glasgow Outcome Scale (GOS) at 3 months. Prognostic strength was quantified by fitting proportional odds logistic regression models. Univariable odds ratios (ORs) were pooled across studies using random effects models. Multivariable analyses were adjusted for fixed effect of study, age, neurological status on admission, other neuroimaging factors, and treatment modality. The neuroimaging predictors were assessed for their added incremental predictive value measured as partial R(2). RESULTS Spline plots indicated outcomes were worse at extremes of aneurysm size, i.e., less than 4 or greater than 9 mm. In between, aneurysm size had no effect on outcome (OR 1.03, 95% CI 0.98-1.09 for 9 mm vs 4 mm, i.e., 75th vs 25th percentile), except in those who were treated conservatively (OR 1.17, 95% CI 1.02-1.35). Compared with anterior cerebral artery aneurysms, posterior circulation aneurysms tended to result in slightly poorer outcome in patients who underwent endovascular coil embolization (OR 1.13, 95% CI 0.82-1.57) or surgical clipping (OR 1.32, 95% CI 1.10-1.57); the relation was statistically significant only in the latter. Fisher CT subarachnoid clot burden was related to outcome in a gradient manner. Each

  16. Parent Artery Occlusion for Intracranial Aneurysms

    PubMed Central

    Cui, Lishan; Peng, Qiang; Ha, Wenbo; Zhou, Dexiang; Xu, Yang

    2009-01-01

    Summary Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally. In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two. Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits. Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved. PMID:20465914

  17. Aortic Aneurysm

    MedlinePlus

    ... these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part of the aorta running through the abdomen Most aneurysms are found during ...

  18. Brain Aneurysm

    MedlinePlus

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  19. Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery

    PubMed Central

    Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

    2016-01-01

    We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke. PMID:27446523

  20. Brain aneurysm repair

    MedlinePlus

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  1. Aortic Aneurysm Statistics

    MedlinePlus

    ... Blood Pressure Salt Cholesterol Million Hearts® WISEWOMAN Aortic Aneurysm Fact Sheet Recommend on Facebook Tweet Share Compartir ... cause of most deaths from aortic aneurysms. Aortic Aneurysm in the United States Aortic aneurysms were the ...

  2. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  3. What Is an Aneurysm?

    MedlinePlus

    ... from the NHLBI on Twitter. What Is an Aneurysm? An aneurysm (AN-u-rism) is a balloon-like bulge ... the weakened or injured walls can cause an aneurysm. An aneurysm can grow large and rupture (burst) ...

  4. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  5. Giant serpentine aneurysm of the distal anterior cerebral artery.

    PubMed

    Senbokuya, Nobuo; Kanemaru, Kazuya; Kinouchi, Hiroyuki; Horikoshi, Toru

    2012-11-01

    We report a case of a 38-year-old man with a giant serpentine aneurysm arising from the distal anterior cerebral artery. This aneurysm grew from a fusiform aneurysm to a huge aneurysm within 5 months before manifesting as a mass lesion. The aneurysm was largely filled with thrombus, and 4 distal branches arose from the aneurysm dome. Selective balloon test occlusion of the distal anterior cerebral artery using an intravascular technique was performed to confirm the tolerance of the brain tissue. The balloon test occlusion elicited adequate leptomeningeal collateral circulation and no neurologic symptoms; thus, the aneurysm was treated with trapping and resection. The patient had no ischemic complications after the surgery and returned to his job 1 month later. No ischemia developed in the 2 years after surgery. Selective balloon test occlusion of the distal cerebral artery using an intravascular technique can be a very useful tool in planning the therapeutic strategy for a complicated distal cerebral aneurysm.

  6. Simultaneous presentation of two cerebral aneurysms.

    PubMed

    Yoshida, Masahiro; Ezura, Masayuki; Sasaki, Kazuto; Chonan, Masashi; Mino, Masaki

    2012-01-01

    A 48-year-old woman experienced sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage (SAH) and intracerebral hematoma in the right frontal lobe. Digital subtraction angiography revealed three aneurysms in the anterior communicating artery (AcomA), the right posterior communicating artery (PcomA), and the right middle cerebral artery. The AcomA aneurysm was treated with endovascular coiling. However, her oculomotor nerve palsy was aggravated after the procedure. Embolization of the right PcomA aneurysm was conducted immediately and her oculomotor nerve palsy recovered completely 3 months later. Simultaneous presentation of multiple aneurysms with separate symptoms is rare. We speculate that the progressive oculomotor nerve palsy was caused by tiny enlargement or morphological change of the aneurysm caused by elevated blood pressure and pulsatile effect after SAH.

  7. [Operation for a giant pseudoaneurysm of the aortic arch without artificial circulation].

    PubMed

    Shlomin, V V; Didenko, Iu P; Puzdriak, P D; Drozhzhin, I G; Bondarenko, P B

    2016-01-01

    Presented herein is a variant of surgical management of a patient with a giant false aneurysm of the aortic arch in the posterior mediastinum. Using the technique of temporary bypass or temporary "debranching" made it possible to carry out a reconstructive intervention without the use of an artificial circulation apparatus. This technique also decreases the necessity of using heparin, thus diminishing the risk of blood loss both during the operation and in the postoperative period. The described variant of the operation for a false aneurysm of the aortic arch extends and supplements the surgeon's capabilities of performing interventions on the aortic arch in the absence of a possibility of using an artificial circulation apparatus both in a scheduled and emergency situation. PMID:27626263

  8. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    PubMed

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms.

  9. Intracranial aneurysm and sildenafil.

    PubMed

    Adiga, Avinash; Edriss, Hawa; Nugent, Kenneth

    2016-04-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  10. Intracranial aneurysm and sildenafil

    PubMed Central

    Edriss, Hawa; Nugent, Kenneth

    2016-01-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  11. Endovascular treatment of intracranial aneurysms.

    PubMed

    Diaz, Orlando; Rangel-Castilla, Leonardo

    2016-01-01

    Intracranial aneurysms are abnormal dilations of the intracranial vessels, in which all the layers of the vascular wall are affected by degenerative changes that lead to distension of the vessel. Intracranial aneurysms can be classified based on their anatomic location, size, and morphology. Subarachnoid hemorrhage is the most devastating clinical presentation. The goal of preventing hemorrhage or rehemorrhage can only be achieved by excluding the aneurysm from the cerebral circulation. Endovascular or surgical clipping can achieve this goal. Multiple surgical and endovascular approaches have been described for treatment of intracranial aneurysm. Surgical approaches for anterior-circulation intracranial aneurysms include: pterional, orbitozygomatic, and lateral supraorbital craniotomies. Modern microsurgical techniques involve skull base dissection to achieve adequate exposure with minimal brain retraction. Endovascular techniques can be divided into: parent artery reconstruction with coil deposition (primary coil, balloon-assisted coiling, stent-assisted coiling, and other new techniques such as neck reconstruction devices and intraluminal occlusion devices); reconstruction with flow diversion; and deconstructive techniques with involving parent artery sacrifice with or without bypass. PMID:27430470

  12. Aneurysms: thoracic aortic aneurysms.

    PubMed

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  13. Intracranial blister aneurysms: clip reconstruction techniques.

    PubMed

    Barrow, Daniel L; Pradilla, Gustavo; McCracken, D Jay

    2015-07-01

    Intracranial blister aneurysms are difficult to treat cerebrovascular lesions that typically affect the anterior circulation. These rare aneurysms can lead to acute rupture which usually cannot be treated via endovascular methods, but still require urgent surgical intervention. Surgical options are limited given their unique pathology and often require a combination of wrapping and clip reconstruction. In this video we present two patients with acute subarachnoid hemorrhage secondary to ruptured blister aneurysms. We demonstrate several surgical techniques for repairing the vascular defect with and without intraoperative rupture. The video can be found here: http://youtu.be/nz-JM45uKQU.

  14. Arterial fenestrations and their association with cerebral aneurysms.

    PubMed

    Patel, Mira A; Caplan, Justin M; Yang, Wuyang; Colby, Geoffrey P; Coon, Alexander L; Tamargo, Rafael J; Huang, Judy

    2014-12-01

    Fenestrations of intracranial arteries and associated aneurysms are rare. The significance of these fenestrations in relation to aneurysms remains unclear. We present four patients with fenestration-associated aneurysms and a comprehensive review of associations with aneurysms and other vascular lesions. A PubMed search of the literature was conducted from 1970-2012 reporting cases of intracranial aneurysms associated with arterial fenestration or duplications. Data were collected on patient presentation, sex, age, aneurysm and fenestration location, aneurysm treatment, and presence of other vascular lesions. We performed a retrospective review of four patients with intracranial fenestrations associated with aneurysms at our institution from 2012-2013. There were 59 cases of fenestrations and associated aneurysms in the literature. Aneurysms were reported as either arising from (n=50) or adjacent to but distinct from (n=13) fenestrations. The most common single fenestration location was at the basilar artery (n=23, 36.5%); however the majority of fenestrations were in the carotid circulation (n=34, 54.0%). The majority of patients with aneurysms and fenestrations at all locations except those at the anterior communicating artery (70.5%) presented with subarachnoid hemorrhage. Patients with aneurysms arising from a fenestration or adjacent to a fenestration presented with an additional intracranial vascular lesion in 38% and 31% of cases, respectively. The majority of all aneurysms were treated with microsurgical clipping. Aneurysms associated with cerebral arterial fenestrations are most commonly discovered after subarachnoid hemorrhage and are most often located in the carotid circulation. A high index of suspicion must be maintained for an associated vascular lesion if an intracranial fenestration is discovered.

  15. Transfundal stent placement for treatment of complex basilar tip aneurysm: technical note

    PubMed Central

    Vasquez, Ciro; Hubbard, Molly; Jagadeesan, Bharathi Dasan; Tummala, Ramachandra Prasad

    2014-01-01

    We describe a case where a complex unruptured basilar tip aneurysm was treated with a unique method of stent-assisted coil embolization. The aneurysm was considered to have a complex anatomy since both the left posterior cerebral artery and left superior cerebellar artery originated from the dome of the aneurysm. Also, the right posterior cerebral artery was incorporated in the aneurysm neck and needed to be protected prior to coil embolization. This case describes placement of a stent across the span of the aneurysm fundus in order to preserve the two branches arising from it, and the aneurysm dome was coiled without any complication. Using modifications of existing strategies for stent-assisted coil embolization, the aneurysm was treated without any complications and all of the vessels at risk were preserved. PMID:25336546

  16. Transfundal stent placement for treatment of complex basilar tip aneurysm: technical note.

    PubMed

    Vasquez, Ciro; Hubbard, Molly; Jagadeesan, Bharathi Dasan; Tummala, Ramachandra Prasad

    2015-10-01

    We describe a case where a complex unruptured basilar tip aneurysm was treated with a unique method of stent-assisted coil embolization. The aneurysm was considered to have a complex anatomy since both the left posterior cerebral artery and left superior cerebellar artery originated from the dome of the aneurysm. Also, the right posterior cerebral artery was incorporated in the aneurysm neck and needed to be protected prior to coil embolization. This case describes placement of a stent across the span of the aneurysm fundus in order to preserve the two branches arising from it, and the aneurysm dome was coiled without any complication. Using modifications of existing strategies for stent-assisted coil embolization, the aneurysm was treated without any complications and all of the vessels at risk were preserved.

  17. Cerebral Aneurysms Fact Sheet

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS Cerebral Aneurysms Fact Sheet See a list of all NINDS ... I get more information? What is a cerebral aneurysm? A cerebral aneurysm (also known as an intracranial ...

  18. A Case of Cerebral Aneurysmal Subarachnoid Hemorrhage in Fabry's Disease

    PubMed Central

    Chang, Youn Hyuk

    2013-01-01

    We report an unusual case of cerebral aneurysmal subarachnoid hemorrage (SAH) with Fabry's disease. A 42-year-old woman presented with aneurysmal SAH originated from a saccular aneurysm of the right posterior communicating artery. The patient was treated by an endovascular coil embolization of aneurysm. Postoperatively the patient recovered favorably without any neurological deficit. During her admission, the patient had a sign of proteinuria in urine analysis. The pathologic findings of kidney needle biopsy implied nephrosialidosis (mucolipidosis of lysosomal stroage disease), which is consistent with a Fabry's disease. It is uncommon that Fabry's disease is presented with aneurysmal SAH, especially in middle-aged patients, but could be a clinical concern. Further investigations are needed to reveal risk factors, vascular anatomy, and causative mechanisms of Fabry's disease with aneurysmal SAH. PMID:23634271

  19. Cerebral aneurysms following radiotherapy for medulloblastoma

    SciTech Connect

    Benson, P.J.; Sung, J.H.

    1989-04-01

    Three patients, two males and one female aged 21, 14, and 31 years, respectively, developed cerebral saccular aneurysms several years after undergoing radiotherapy for cerebellar medulloblastoma at 2, 5, and 14 years of age, respectively. Following surgery, all three received combined cobalt-60 irradiation and intrathecal colloidal radioactive gold (/sup 198/Au) therapy, and died from rupture of the aneurysm 19, 9, and 17 years after the radiotherapy, respectively. Autopsy examination revealed no recurrence of the medulloblastoma, but widespread radiation-induced vasculopathy was found at the base of the brain and in the spinal cord, and saccular aneurysms arose from the posterior cerebral arteries at the basal cistern or choroidal fissure. The aneurysms differed from the ordinary saccular aneurysms of congenital type in their location and histological features. Their locations corresponded to the areas where intrathecally administered colloidal /sup 198/Au is likely to pool, and they originated directly from a segment of the artery rather than from a branching site as in congenital saccular aneurysms. It is, therefore, concluded that the aneurysms in these three patients were most likely radiation-induced.

  20. Extracranial arterial aneurysms: a cause of crescendo transient ischaemic attacks.

    PubMed

    Paterson, H M; Holdsworth, R J

    2000-12-01

    Crescendo transient ischaemic attacks (TIAs) should be regarded as a medical emergency. Patients require hospitalisation with urgent assessment and symptom control with anticoagulant therapy. We report on three patients, all of whom had atherosclerotic aneurysmal disease of the extracranial arterial circulation who presented with crescendo TIAs. The possibility of extracranial aneurysmal disease should always be considered and excluded.

  1. Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

    PubMed Central

    Lee, Sang Kook

    2013-01-01

    Objective Although surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications. Methods Between September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography. Results Of the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely. Conclusion The key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms. PMID:24527189

  2. Flow diversion for complex intracranial aneurysms in young children.

    PubMed

    Navarro, Ramon; Brown, Benjamin L; Beier, Alexandra; Ranalli, Nathan; Aldana, Philipp; Hanel, Ricardo A

    2015-03-01

    Pediatric intracranial aneurysms are exceedingly rare and account for less than 5% of all intracranial aneurysms. Open surgery to treat such aneurysms has been shown to be more durable than endovascular techniques, and durability of treatment is particularly important in the pediatric population. Over the past 2 decades, however, a marked shift in aneurysm treatment from open surgery toward endovascular procedures has occurred for adults. The authors describe their early experience in treating 3 unruptured pediatric brain aneurysms using the Pipeline embolization device (PED). The first patient, a girl with Majewski osteodysplastic primordial dwarfism Type II who was harboring multiple intracranial aneurysms, underwent two flow diversion procedures for a vertebrobasilar aneurysm and a supraclinoid internal carotid artery aneurysm. The second patient underwent PED placement on a previously coiled but enlarging posterior communicating artery aneurysm. All procedures were uneventful, with no postsurgical complications, and led to complete angiographic obliteration of the aneurysms. To the authors' knowledge, this is the first series of flow diversion procedures in children reported in the medical literature. While flow diversion is a new and relatively untested technology in children, outcomes in adults have been promising. For challenging lesions in the pediatric population, flow diversion may have a valuable role as a well-tolerated, safe treatment with durable results. Many issues remain to be addressed, such as the durability of flow diverters over a very long follow-up and vessel response to growth in the presence of an endoluminal device.

  3. Flow diversion for complex intracranial aneurysms in young children.

    PubMed

    Navarro, Ramon; Brown, Benjamin L; Beier, Alexandra; Ranalli, Nathan; Aldana, Philipp; Hanel, Ricardo A

    2015-03-01

    Pediatric intracranial aneurysms are exceedingly rare and account for less than 5% of all intracranial aneurysms. Open surgery to treat such aneurysms has been shown to be more durable than endovascular techniques, and durability of treatment is particularly important in the pediatric population. Over the past 2 decades, however, a marked shift in aneurysm treatment from open surgery toward endovascular procedures has occurred for adults. The authors describe their early experience in treating 3 unruptured pediatric brain aneurysms using the Pipeline embolization device (PED). The first patient, a girl with Majewski osteodysplastic primordial dwarfism Type II who was harboring multiple intracranial aneurysms, underwent two flow diversion procedures for a vertebrobasilar aneurysm and a supraclinoid internal carotid artery aneurysm. The second patient underwent PED placement on a previously coiled but enlarging posterior communicating artery aneurysm. All procedures were uneventful, with no postsurgical complications, and led to complete angiographic obliteration of the aneurysms. To the authors' knowledge, this is the first series of flow diversion procedures in children reported in the medical literature. While flow diversion is a new and relatively untested technology in children, outcomes in adults have been promising. For challenging lesions in the pediatric population, flow diversion may have a valuable role as a well-tolerated, safe treatment with durable results. Many issues remain to be addressed, such as the durability of flow diverters over a very long follow-up and vessel response to growth in the presence of an endoluminal device. PMID:25555114

  4. Aneurysm flow characteristics in realistic carotid artery aneurysm models induced by proximal virtual stenotic plaques: a computational hemodynamics study

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Peloc, Nora L.; Chien, Aichi; Goldberg, Ezequiel; Putman, Christopher M.; Cebral, Juan R.

    2015-03-01

    Cerebral aneurysms may rarely coexist with a proximal artery stenosis. In that small percent of patients, such coexistence poses a challenge for interventional neuroradiologists and neurosurgeons to make the best treatment decision. According to previous studies, the incidence of cerebral aneurysms in patients with internal carotid artery stenosis is no greater than five percent, where the aneurysm is usually incidentally detected, being about two percent for aneurysms and stenoses in the same cerebral circulation. Those cases pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The aim of this study is to investigate the intra-aneurysmal hemodynamic changes before and after treatment of stenotic plaque. Virtually created moderate stenoses in vascular models of internal carotid artery aneurysm patients were considered in a number of cases reconstructed from three dimensional rotational angiography images. The strategy to create those plaques was based on parameters analyzed in a previous work where idealized models were considered, including relative distance and stenosis grade. Ipsilateral and contralateral plaques were modeled. Wall shear stress and velocity pattern were computed from finite element pulsatile blood flow simulations. The results may suggest that wall shear stress changes depend on relative angular position between the aneurysm and the plaque.

  5. Dissecting Aneurysm of the Basilar Arterial Trunk Presenting with Pontine Infarction

    PubMed Central

    Jang, Y.-G.; Ryu, C.W.; Kim, J.S.; Cha, E.Y.; Pyun, H.W.; Kim, D.Y.; Choi, J.W.; suh, D.C.

    2007-01-01

    Summary Dissecting basilar aneurysms have rarely been reported but are associated with high morbidity and mortality. Therefore, controversy exists as to the proper management of such lesions because their natural course is not well understood. We describe a 50-year-old man with a dissecting aneurysm involving the lower basilar trunk who presented with pontine infarction corresponding to the aneurysmal sac location. We obliterated the dissecting basilar aneurysm by coil embolization of the aneurysmal sac as well as the diseased segment of the basilar trunk after confirmation of collateral filling of the basilar artery through the posterior communicating artery. The patient recovered without any procedural complication. Eight month follow-up revealed complete disappearance of the aneurysm without symptom recurrence together with preservation of collateral flow in the distal basilar artery. Obliteration of the parent artery as well as the aneurysmal sac with coils could be considered in a lower basilar aneurysm of a dissecting nature. PMID:20566107

  6. Prenatal diagnosis of ductus arteriosus aneurysm.

    PubMed

    Ganesan, S; Hutchinson, D P; Sampson, A J

    2015-11-01

    The ductus arteriosus holds major functional importance within the fetal circulation, and anomalies within the ductus arteriosus may interfere with the integrity of the fetal circulation. Ductus arteriosus aneurysm, previously considered a rare lesion, is now a well-reported finding in infancy with some reports describing this finding in the prenatal period. Postnatally, most ductus arteriosus aneurysms resolve spontaneously; however, a small group of infants show complications such as connective-tissue disorders, thrombo-embolism, compression of surrounding thoracic structures and life-threatening spontaneous rupture requiring surgical correction. As such, postnatal assessment in this group is recommended. PMID:27433265

  7. One-stage operation for rare multiple mirror intracranial aneurysms: a case report and literature review.

    PubMed

    Xu, Yan; Chen, Shu-da; Lei, Bin; Zhang, Wei-Hua; Wang, Wei-Yu

    2014-01-01

    Although intracranial multiple aneurysms are not uncommon, multiple mirror aneurysms are relatively rare. A few isolated cases have been described. However, to the best of our knowledge, 3 pairs of pure symmetrical mirror aneurysms in one patient have not been reported yet. We present a case of multiple mirror aneurysms involving the bilateral middle cerebral artery (MCA) bifurcations and posterior communicating arteries (P-com A) confirmation by one-stage operation. The possibility of one-stage treatment must be considered before surgery. Missed diagnosis and misdiagnosis must be avoided before one-stage operation for multiple mirror aneurysms.

  8. Hemodynamic Impact of a Spontaneous Cervical Dissection on an Ipsilateral Saccular Aneurysm

    PubMed Central

    See, Alfred P.; Penn, David L.; Du, Rose; Frerichs, Kai U

    2016-01-01

    The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.

  9. Coil Embolization of Pancreaticoduodenal Artery Aneurysms Associated with Celiac Artery Stenosis: Report of Three Cases

    SciTech Connect

    Ikeda, Osamu Tamura, Yoshitaka; Nakasone, Yutaka; Kawanaka, Kohichi; Yamashita, Yasuyuki

    2007-06-15

    Aneurysms of the pancreaticoduodenal artery are rare. Degeneration of pancreaticoduodenal arcade vessels due to these aneurysms is associated with celiac artery stenosis or occlusion. Untreated lesions enlarge progressively and may rupture spontaneously. As the location of aneurysms of pancreaticoduodenal arcade vessels renders their surgical extirpation a challenge, we examined whether endovascular techniques offer a treatment alternative. We report on 3 patients with aneurysms of the pancreaticoduodenal arcade vessels and concomitant celiac artery stenosis/occlusion due to compression by the median arcuate ligament or chronic pancreatitis. All patients were treated by percutaneous coil embolization of the aneurysm. The aneurysmal sac was successfully excluded and the native circulation was preserved. Endovascular surgery can be used to treat these aneurysms safely and permits retention of the native circulation.

  10. How Is an Aneurysm Treated?

    MedlinePlus

    ... NHLBI on Twitter. How Is an Aneurysm Treated? Aortic aneurysms are treated with medicines and surgery. Small aneurysms ... doing your normal daily activities Treatment for an aortic aneurysm is based on its size. Your doctor may ...

  11. Neurofibromatosis Type 1: Transcatheter Arterial Embolization for Ruptured Occipital Arterial Aneurysms

    SciTech Connect

    Kanematsu, Masayuki; Kato, Hiroki; Kondo, Hiroshi; Goshima, Satoshi; Tsuge, Yusuke; Kojima, Toshiaki; Watanabe, Haruo

    2011-02-15

    Two cases of ruptured aneurysms in the posterior cervical regions associated with type-1 neurofibromatosis treated by transcatheter embolization are reported. Patients presented with acute onset of swelling and pain in the affected areas. Emergently performed contrast-enhanced CT demonstrated aneurysms and large hematomas widespread in the posterior cervical regions. Angiography revealed aneurysms and extravasations of the occipital artery. Patients were successfully treated by percutaneous transcatheter arterial microcoil embolization. Transcatheter arterial embolization therapy was found to be an effective method for treating aneurysmal rupture in the posterior cervical regions occurring in association with type-1 neurofibromatosis. A literature review revealed that rupture of an occipital arterial aneurysm, in the setting of neurofibromatosis type 1, has not been reported previously.

  12. Hemodynamic impact of cerebral aneurysm endovascular treatment devices: coils and flow diverters.

    PubMed

    Goubergrits, Leonid; Schaller, Jens; Kertzscher, Ulrich; Woelken, Thies; Ringelstein, Moritz; Spuler, Andreas

    2014-07-01

    Coils and flow diverters or stents are devices successfully used to treat cerebral aneurysms. Treatment aims to reduce intra-aneurysmal flow, thereby separating the aneurysmal sac from the blood circulation. The focus and this manuscript combining literature review and our original research is an analysis of changes in aneurysmal hemodynamics caused by endovascular treatment devices. Knowledge of post-treatment hemodynamics is a path to successful long-term treatment. Summarizing findings on hemodynamic impact of treatment devices, we conclude: coiling and stenting do not affect post-treatment intra-aneurysmal pressure, but significantly alter aneurysmal hemodynamics through flow reduction and a change in flow structure. The impact of treatment devices on aneurysmal flow depends, however, on a set of parameters including device geometry, course of placement, parent vessel and aneurysm geometry.

  13. Growth and subsequent disappearance of a ruptured small saccular intracranial aneurysm: A morphometric and flow-dynamic analysis.

    PubMed

    Peruvumba, Jayakumar Narayan; Paul, Divyan; Verghese, Renjan

    2016-10-01

    The growth of a ruptured small saccular aneurysm has rarely been documented. Also rare are reports of spontaneous thrombosis of ruptured small intracranial saccular aneurysms. However, there are no reported instances of ruptured small saccular aneurysms that have demonstrated an increase in size after rupture, subsequently thrombosed and disappeared from circulation. We report one such aneurysm in a patient who presented with subarachnoid hemorrhage from a ruptured small saccular aneurysm of the anterior communicating artery. The possible reasons for the initial growth and subsequent thrombosis of the aneurysm from morphometric and flow dynamic points of view are discussed. PMID:27470928

  14. [Aortic aneurysm].

    PubMed

    Villar, Fernando; Pedro-Botet, Juan; Vila, Ramón; Lahoz, Carlos

    2013-01-01

    Aortic aneurysm is one important cause of death in our country. The prevalence of abdominal aortic aneurism (AAA) is around 5% for men older than 50 years of age. Some factors are associated with increased risk for AAA: age, hypertension, hypercholesterolemia, cardiovascular disease and, in particular, smoking. The medical management of patients with an AAA includes cardiovascular risk treatment, particularly smoking cessation. Most of major societies guidelines recommend ultrasonography screening for AAA in men aged 65 to 75 years who have ever smoked because it leads to decreased AAA-specific mortality. PMID:24238836

  15. [Endosaccular embolization of an intrasellar aneurysm with hypopituitarism: case report].

    PubMed

    Fujii, Mutsumi; Tone, Osamu; Tomita, Hiroki; Tamaki, Masashi; Akimoto, Hideaki; Shigeta, Keigo; Sampetrean, Oltea; Kanno, Kazuo; Matsushita, Mika

    2008-04-01

    An 81-year-old male presented with weight loss and hyponatremia. A baseline endocrinological examination revealed anterior pituitary dysfunction. A computed tomography and MRI revealed a large, unruptured intrasellar aneurysm protruding from the right internal carotid artery and pushing the pituitary stalk leftward. The patient developed polyuria and polydipsia from 10 days after commencing corticosteroid supplementation and was diagnosed with partial central diabetes insipidus (DI). Balloon assisted endosaccular embolization was performed about one month after the posterior pituitary dysfunction was identified. The unruptured aneurysm was successfully embolized with Guglielmi detachable coils (GDCs) without narrowing of the parent vessel. DI resolved completely and the posterior pituitary dysfunction improved soon after endosaccular embolization. The remission of DI after coil embolization suggested that the DI might have been induced by the progressive mass effect of the aneurysm rather than by the steroid. An endocrinological evaluation and cerebral angiography confirmed partial recovery of anterior pituitary dysfunction and almost complete obliteration of the aneurysm, respectively at 1 year after the operation. We report a case of hypopituitarism secondary to the large intrasellar aneurysm. This aneurysm was embolized with GDCs, resulting in partial recovery of anterior pituitary dysfunction and complete recovery of posterior pituitary dysfunction.

  16. Endovascular Management of Complex Renal Artery Aneurysms Using the Multilayer Stent

    SciTech Connect

    Meyer, Carsten; Verrel, Frauke; Weyer, Gunther Wilhelm, Kai

    2011-06-15

    Since its approval as an innovative stent system for peripheral aneurysm management in May 2009, the Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) has been applied in several clinical cases. The unique design of this multilayer stent decreases mean velocity and vorticity within the aneurysm sac immediate and causes thrombus to form, resulting in physiological exclusion of the aneurysm from the circulation, whereas branches and collaterals sprouting from the aneurysm remain patent. Here we present a case of a complex renal artery aneurysm successfully treated with a 6 Multiplication-Sign 30-mm Cardiatis Multilayer Stent.

  17. The energy loss may predict rupture risks of anterior communicating aneurysms: a preliminary result.

    PubMed

    Hu, Peng; Qian, Yi; Lee, Chong-Joon; Zhang, Hong-Qi; Ling, Feng

    2015-01-01

    Anterior communicating artery (ACoA) aneurysms are well documented to have a higher rupture risk compared with aneurysms at other locations. However, the risk predicting factors for these aneurysms still remain unclear due to the complex arteries geometries and flow patterns involved. The authors introduce a comprehensive method to quantitatively illustrate the development of ACoA aneurysms using a computational fluid dynamics (CFD) approach. Seven ACoA aneurysms, which included 2 ruptured and 5 unruptured aneurysms, were employed. Patient-specific whole anterior circulation geometries were segmented to simulate the real circumstances in vivo. The energy losses (EL) and flow architectures of these 7 aneurysms were evaluated using an algorithm modality. Overall, the 2 ruptured aneurysms, along with 1 unruptured aneurysm that was defined as highly likely to rupture due to ACoA location and a bleb sitting at the top of the dome, had a significantly larger EL and more complex and unstable flow architecture than the others. Two aneurysms had a negative value of EL indicating that the geometries with aneurysms of the anterior communicating complex (ACC) had a smaller loss of energy than the geometries without aneurysms. Despite a small sample size resulting in a low statistical significance, EL may serve as a development predictor of ACoA aneurysms. PMID:26064320

  18. Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage Associated with Bilateral Common Carotid Artery Occlusion

    PubMed Central

    Meguro, T.; Tanabe, T.; Muraoka, K.; Terada, K.; Hirotsune, N.; Nishino, S.

    2008-01-01

    Summary Cases of aneurysm associated with the occlusion of both common carotid arteries are very rare. We present a case of ruptured aneurysms of the basilar bifurcation and posterior cerebral artery coexisting with bilateral common carotid artery occlusion, successfully treated by endovascular coil embolization with a double-balloon remodeling technique. Finally, we review the literature. A 62-year-old woman presented with severe headache; a computed tomography scan demonstrated subarachnoid hemorrhage. Angiography revealed that the bilateral common carotid arteries were occluded. The muscle branches of the vertebral arteries had anastomosed to the bilateral external carotid arteries. Bilateral posterior communicating arteries had developed and supplied the bilateral internal carotid arteries. Two aneurysms (a saccular aneurysm of the P1 portion of the left posterior cerebral artery and a wide-necked aneurysm of the basilar bifurcation) were also observed. Endovascular embolization of the aneurysms was successfully performed using a double-balloon remodeling technique. The patient made a full recovery after treatment, and the aneurysms remained obliterated 12 months after embolization. We believe that this is the first report of ruptured aneurysms associated with bilateral common carotid artery occlusion successfully treated by endovascular coiling. The double-balloon remodeling technique was useful for treatment of wide-necked basilar bifurcation aneurysm. PMID:20557745

  19. Cerebral aneurysm (image)

    MedlinePlus

    ... loss of nerve function may indicate that an aneurysm may be causing pressure on adjacent brain tissue. ... changes or other neurological changes can indicate the aneurysm has ruptured and is bleeding into the brain. ...

  20. Cerebral aneurysm (image)

    MedlinePlus

    ... area within the vessel wall. If a cerebral (brain) aneurysm ruptures, the escaping blood within the brain may cause severe neurologic complications or death. A person who has a ruptured cerebral aneurysm may complain of the sudden onset of "the ...

  1. [Abdominal aortic aneurysm. Endovascular treatment with fenestrated endoprothesis].

    PubMed

    Rostagno, Román; Cesareo, Vicente; García-Mónaco, Ricardo; Peralta, Oscar; Domenech, Alberto; Bracco, Daniel

    2008-01-01

    Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.

  2. Hemodynamic Alterations after Stent Implantation in 15 Cases of Intracranial Aneurysms

    PubMed Central

    Wang, Chao; Tian, Zhongbin; Liu, Jian; Jing, Linkai; Paliwal, Nikhil; Wang, Shengzhang; Zhang, Ying; Xiang, Jianping; Siddiqui, Adnan H; Meng, Hui; Yang, Xinjian

    2016-01-01

    Background Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and its association with aneurysm location. Methods We first retrospectively studied 15 aneurysm cases (8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms) treated with Enterprise stents and coils. Then based on patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. Results Before and after stent deployment, the average Wall Shear Stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; and the spatially averaged value of flow velocity in the perpendicular plane of aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post-stent implantation, WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4% (P = 0.012) and 16.6% (P = 0.018) respectively, and flow velocity also reduced by 10.3% (P = 0.029) and 10.5% (P = 0.013), respectively. Changes in WSS, flow velocity, and pressure were not significantly different between ICA-OphA aneurysms and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in both aneurysm types. Conclusion After stent implantation, intra-aneurysmal flow velocity and WSS decreased independent of aneurysm type (ICA-OphA and PcoA). Little change was observed on peak systolic pressure. PMID:26746828

  3. Pediatric isolated bilateral iliac aneurysm.

    PubMed

    Chithra, R; Sundar, R Ajai; Velladuraichi, B; Sritharan, N; Amalorpavanathan, J; Vidyasagaran, T

    2013-07-01

    Aneurysms are rare in children. Isolated iliac artery aneurysms are very rare, especially bilateral aneurysms. Pediatric aneurysms are usually secondary to connective tissue disorders, arteritis, or mycotic causes. We present a case of a 3-year-old child with bilateral idiopathic common iliac aneurysms that were successfully repaired with autogenous vein grafts.

  4. Embolization of Brain Aneurysms and Fistulas

    MedlinePlus

    ... Professions Site Index A-Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms ... Aneurysms and Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous ...

  5. Endovascular Treatment of a Renal Artery Branch Aneurysm

    SciTech Connect

    Malacrida, G.; Dalainas, Ilias Medda, Massimo; Nano, Giovanni; Inglese, Luigi

    2007-02-15

    A 58-year-old woman was admitted to our institution because of a left renal artery branch saccular aneurysm with a 2 cm diameter. Due to a hostile abdomen and the infrarenal location, an endovascular approach was chosen. A Jostent Peripheral Stent-Graft was placed under angiographic control, excluding the aneurysm from the circulation. No peri- or postprocedural complications were observed. At 6 months follow-up, the endograft is patent, excluding the aneurysm. Endovascular treatment may represent an alternative to surgery, especially in the distal infraparenchymal location.

  6. Retroesophageal subclavian artery aneurysm arising from Kommerell's diverticulum.

    PubMed

    Sala, F; Bouillane, P J; Francisci, M P; Diaz, F; Lena, P; Kreitmann, P; Batt, M

    2001-11-01

    This report describes a novel technique used for management of retroesophageal subclavian artery aneurysm arising from Kommerell's diverticulum. The procedure consists of endoaortic exclusion of the aneurysmal neck, using a prosthetic patch after sternotomy during circulatory arrest, and antegrade cold blood cerebroplegia. The advantages of this technique are avoidance of hemorrhagic complications during clamping of the aneurysmal neck, limiting of the extent of dissection of the aortic arch, and elimination of the risk of inadvertent left recurrent nerve paralysis. Antegrade cold blood cerebroplegia provides good cerebral protection and decreases the duration and consequences of extracorporeal circulation.

  7. A Staged Hybrid Procedure to Manage Complex Cerebral Hypoperfusion in Aortic Arch Aneurysm.

    PubMed

    Hernández Carbonell, Teresa; Haulon, Stephan; Prat, Alain; Martin-Gonzalez, Teresa; Tyrrell, Mark R; Sobocinski, Jonathan

    2015-10-01

    We report the management of a patient who had an open-surgical repair following traumatic avulsion of the supra-aortic trunks (SAT) 30 years prior to presentation with a large arch aneurysm and poor cerebral collaterals. "Simple" thoracic endovascular aneurysm repair (TEVAR) was not an option because it would have excluded the collateral circulation to the carotid and vertebral arteries. We devised a two-stage hybrid procedure to repair this challenging aneurysm.

  8. Computational analysis of anterior communicating artery aneurysm shear stress before and after aneurysm formation

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2011-12-01

    It is widely accepted that complexity in the flow pattern at the anterior communicating artery (AComA) is associated with the high rate of aneurysm formation at that location observed in large studies. The purpose of this work is to study associations between hemodynamic patterns, and AComA aneurysm initiation by comparing hemodynamics in the aneurysm and the normal model where the aneurysm was computationally removed. Vascular models of both right and left circulation were independently reconstructed from three-dimensional rotational angiography images using deformable models after image registration of both images, and fused using a surface merging algorithm. The geometric models were then used to generate high-quality volumetric finite element grids of tetrahedra with an advancing front technique. For each patient, the second anatomical model was created by digitally removing the aneurysm. It was iteratively achieved by applying a Laplacian smoothing filter and remeshing the surface. Finite element blood flow numerical simulations were performed for both the pathological and normal models under the same personalized pulsatile flow conditions imposed at the inlets of both models. The Navier-Stokes equations were numerically integrated by using a finite-element formulation. It was observed that aneurysms initiated in regions of high and moderate WSS in the counterpart normal models. Adjacent or close to those regions, low WSS portions of the arterial wall were not affected by the disease. These results are in line with previous observations at other vascular locations.

  9. Pure tentorial subdural hematoma from rupture of aneurysm along the transmastoid branches of the occipital artery

    PubMed Central

    Nguyen, Ha Son; Doan, Ninh; Shabani, Saman; Gelsomino, Michael; Zaidat, Osama

    2016-01-01

    Background: Pure subdural hematoma (without subarachnoid, intraventricular, or intraparenchymal hemorrhage) due to a ruptured intracranial aneurysm is rare. Most reported cases involve an aneurysm along the internal carotid artery, posterior communicating artery, or middle cerebral artery. No reports have described an aneurysm along the transmastoid branches of the occipital artery. Case Description: A 70-year-old female presented with sudden-onset, excruciating headaches, associated with dizziness, nausea, and emesis. There was no history of trauma. Computed tomography (CT) head demonstrated a pure tentorial subdural hematoma. Vascular imaging revealed bilateral aneurysms along the transmastoid branches of the intracranial portion of both the occipital arteries. Consequently, these branches were embolized, with no residual filling of the aneurysms. After the procedure, the patient remained neurologically well. The patient was monitored appropriately for vasospasm, and was discharged home 10 days after presentation. Conclusion: Rupture of aneurysms along intracranial branches of the occipital artery can lead to pure subdural hematoma along the tentorium. PMID:27583173

  10. Surgical clipping of a recurrent small saccular aneurysm after repeated coil embolization.

    PubMed

    Yoshida, Kazumichi; Wataya, Takafumi; Hojo, Masato; Doi, Daisuke; Yamagata, Sen

    2005-07-01

    A 59-year-old healthy woman presented with sudden onset of severe headache. Computed tomography and digital subtraction angiography (DSA) demonstrated subarachnoid hemorrhage (grade I according to the Hunt and Hess classification) due to a ruptured small right posterior cerebral artery (PCA) aneurysm. The ruptured PCA aneurysm was completely embolized with three Guglielmi detachable coils (GDCs). However, follow-up DSA 3 months after the initial coiling confirmed refilling of the aneurysm. The aneurysm was successfully re-embolized with two GDCs. Follow-up DSA 10 months later revealed regrowth of the aneurysm. Surgical clipping was performed without compromising the parent vessels. Long-term angiographic follow up is necessary even in patients with small saccular aneurysms which are apparently completely embolized by endovascular coil treatment.

  11. Antegrade Recanalization of Parent Artery after Internal Trapping of Ruptured Vertebral Artery Dissecting Aneurysm

    PubMed Central

    Sung, Jae Hoon; Byun, Je Hoon

    2012-01-01

    We report a patient with a ruptured vertebral artery (VA) dissecting aneurysm that was treated by internal trapping of the aneurysm and parent artery using detachable coils with subsequent antegrade recanalization of occluded vertebral artery during the follow-up period. A 38-year-old man was admitted with a ruptured right VA dissecting aneurysm just distal to origin of right posterior inferior cerebellar artery. The dissected segment of the VA was occluded by coil embolization. The 14 months follow-up angiography showed that dissected aneurysm was completely occluded, but the parent artery was recanalized in an antegrade fashion. Based on this unique case, the authors suggest that careful angiographic follow-up of dissecting aneurysm is required, even in patients successfully treated with endovascular occlusion of the affected artery and aneurysm. PMID:22792429

  12. Massive bleeeding from upper gastrointestinal tract as a symptom of rupture of splenic artery aneurysm to stomach

    PubMed Central

    Wierzbicki, Tomasz; Szmeja, Jacek; Borejsza-Wysocki, Maciej; Męczyński, Michał; Smuszkiewicz, Piotr; Katulska, Katarzyna; Drews, Michał

    2012-01-01

    Summary Background Splenic artery aneurysm is the most common aneurysm of visceral vessels. Their rupture usually leads to massive bleeding, being a direct life threat. Splenic artery aneurysms usually rupture into the free peritoneal cavity, and much less frequently into the lumen of the gastrointestinal tract. Case Report We describe the case of a 38-year-old male patient, who, as a result of chronic pancreatitis, developed a false aneurysm of the splenic artery, which initially caused necrosis of the large intestine and bleeding into its lumen, and subsequently necrosis of the posterior stomach wall with the aneurysm rupture to the stomach lumen with a dramatic course. Conclusions The case described confirms that splenic artery aneurysm can be a cause of bleeding to both upper and lower parts of the gastrointestinal tract, and the aneurysm rupture is usually of a dramatic and life-threatening course. PMID:22293886

  13. [Thoracoabdominal aortic aneurysm].

    PubMed

    Kalder, J; Kotelis, D; Jacobs, M J

    2016-09-01

    Thoracoabdominal aortic aneurysms (TAAA) are rare events with an incidence of 5.9 cases per 100,000 persons per year. In Germany approximately 940 TAAA procedures are performed annually. The cause of TAAA is mostly degenerative but they can also occur on the basis of an aortic dissection or connective tissue disease (e. g. Marfan's syndrome). Patients often have severe comorbidities and suffer from hypertension, coronary heart disease or chronic obstructive pulmonary disease, mostly as a result of smoking. Operative treatment is indicated when the maximum aortic diameter has reached 6 cm (> 5 cm in patients with connective tissue disease) or the aortic diameter rapidly increases (> 5 mm/year). Treatment options are open surgical aortic repair with extracorporeal circulation, endovascular repair with branched/fenestrated endografts and parallel grafts (chimneys) or a combination of open and endovascular procedures (hybrid procedures). Mortality rates after both open and endovascular procedures are approximately 8 % depending on the extent of the repair. Furthermore, there are relevant risks of complications, such as paraplegia (up to 20 %) and the necessity for dialysis. In recent years several approaches to minimize these risks have been proposed. Besides cardiopulmonary risk evaluation, clinical assessment of patients by the physician with respect to the patient-specific anatomy influences the allocation of patients to one treatment option or another. Surgery of TAAA should ideally be performed in high-volume centers in order to achieve better results. PMID:27558261

  14. The False Aneurysm

    PubMed Central

    Baird, R. J.; Doran, M. L.

    1964-01-01

    The clinical course of 18 patients with 25 false aneurysms is reviewed. In recent years false aneurysm has been most commonly seen as a complication of arterioplastic procedures in which prosthetic arterial grafts were used. The use of indwelling needles or cannulae, particularly in patients with a wide arterial pulse pressure, can also lead to the formation of false aneurysms. In the groin, a false aneurysm is frequently mistaken for an abscess. Early diagnosis and operative repair are essential to reduce the incidence of further complications. PMID:14180533

  15. Cephalic vein aneurysm.

    PubMed

    Faraj, Walid; Selmo, Francesca; Hindi, Mia; Haddad, Fadi; Khalil, Ismail

    2007-11-01

    Cephalic vein aneurysms are rare malformations that may develop in any part of the vascular system, and their history, presentation, and management vary depending on their site. The etiology of venous aneurysms remains unclear, although several theories have been elaborated. Venous aneurysms are unusual vascular malformations that occur equally between the sexes and are seen at any age; they can present as either a painful or a painless subcutaneous mass. No serious complications have been reported from upper extremity venous aneurysms. Surgical excision is the definitive management for most of these. The case reported here presented with a painless and mobile, soft, subcutaneous mass that caused only cosmetic concern.

  16. Endovascular Coiling of Aneurysm Remnants after Clipping in Patients with Follow-up

    PubMed Central

    Mangiafico, S.; Cellerini, M.; Villa, G.; Ammannati, F.; Paoli, L.; Mennonna, P.

    2005-01-01

    Summary The vast majority of intracranial aneurysms can be obliterated completely with surgical clipping. However, postoperative remnants occur in about 4 to 8% of patients who undergo postoperative angiography. Endovascular embolization has been successfully performed in patients with postoperative aneurysm remnant and it may represent a therapeutic alternative to surgical reintervention. Twelve aneurysm remnants after surgical clipping were treated with endovascular embolization using GDC. All aneurysms were located in the anterior circulation. Our experience confirms the feasibility and relative safety of this treatment strategy that may be considered a valid alternative to reintervention. PMID:20584434

  17. Ruptured aneurysm of major aortopulmonary collateral artery: management using amplatzer vascular plug

    PubMed Central

    Kumar, Sanjeev; Priya, Sarv

    2016-01-01

    Aneurysm of a major aortopulmonary collateral artery (MAPCA) is quite rare. Aneurysmally dilated MAPCA may be complicated with rupture and massive hemoptysis leading to sudden death. Possible pathophysiology for aneurysm formation is persistent high pressure state in collateral circulation. High index of suspicion is necessary to avoid catastrophic complications as the amount of hemoptysis does not correlate with disease severity and etiology. We present a case of large ruptured aneurysm of a MAPCA presenting with massive haemoptysis in a patient of cyanotic congenital heart disease which was salvaged by endovascular deployment of vascular plug. PMID:27280092

  18. Bronchial Aneurysms Mimicking Aortic Aneurysms: Endovascular Treatment in Two Patients

    SciTech Connect

    Vernhet, Helene; Bousquet, Claudine; Jean, Betty; Lesnik, Alvian; Durand, Gerard; Giron, Jacques; Senac, Jean Paul

    1999-05-15

    Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.

  19. [Unusual aneurysm of the pancreas arcade in occlusion of the celiac trunk].

    PubMed

    Wrazidlo, W; Jonas, J; Wittek, M

    1987-12-01

    This is a report about a rare aneurysm of the pancreas arcade--the angiography showing an occlusion of the celiac axis. Using a diagram of the arterial phase of the angiography, the morphology of the collateral circulation between the celiac axis and the superior mesenteric artery is described. The reason the occlusion of the celiac axis formed collateral circulation and the origin of the aneurysm and the therapeutic steps to be taken are discussed. PMID:3438460

  20. Abdominal aortic aneurysm.

    PubMed

    Keisler, Brian; Carter, Chuck

    2015-04-15

    Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate. PMID:25884861

  1. Complications in the Treatment of Intracranial Aneurysms with Silk Stents: an Analysis of 30 Consecutive Patients

    PubMed Central

    Cirillo, L.; Leonardi, M.; Dall’olio, M.; Princiotta, C.; Stafa, A.; Simonetti, L.; Toni, F.; Agati, R.

    2012-01-01

    Summary Flow-diverting stents (Silk and PED) have radically changed the approach to intracranial aneurysm treatment from the use of endosaccular materials to use of an extraaneurysmal endoluminal device. However, much debate surrounds the most appropriate indications for the use of FD stents and the problems raised by several possible complications. We analysed our technical difficulties and the early (less than ten days after treatment) and late complications encountered in 30 aneurysms treated comprising 13 giant lesions, 12 large, five with maximum diameters <10 mm and one blister-like aneurysm. In our experience the primary indications for the use of FD stents can be the symptomatic intracavernous giant aneurysms. Although the extracavernous carotid siphon aneurysms have major risk of bleeding, FD stents are indicated clearly explaining the risks to the patient in case of severe mass effect. There is a very complex assessment for aneurysms of the vertebrobasilar circulation. PMID:23217636

  2. Brain aneurysm repair - discharge

    MedlinePlus

    ... Supplements Videos & Tools Español You Are Here: Home → ... You had a brain aneurysm. An aneurysm is a weak area in the wall of a blood vessel that bulges or balloons out. Once it reaches a certain size, it ...

  3. Aneurysm in the brain

    MedlinePlus

    ... aneurysm may be found when an MRI or CT scan of the brain is done for another reason. A brain aneurysm ... and determine the cause of bleeding in the brain: Cerebral angiography or spiral CT scan angiography of the head to show the location ...

  4. Post-Treatment Hemodynamics of a Basilar Aneurysm and Bifurcation

    PubMed Central

    Ortega, J.; Hartman, J.; Rodriguez, J.; Maitland, D.

    2009-01-01

    To investigate whether or not a successful aneurysm treatment procedure can subject a parent artery to harmful hemodynamic stresses, computational fluid dynamics simulations are performed on a patient-specific basilar aneurysm and bifurcation before and after a virtual endovascular treatment. Prior to treatment, the aneurysm at systole is filled with a periodic train of vortex tubes, which form at the aneurysm neck and advect upwards into the dome. Following the treatment procedure however, the motion of the vortex train is inhibited by the aneurysm filling material, which confines the vortex tubes to the region beneath the aneurysm neck. Analysis of the post-treatment flow field indicates that the impingement of the basilar artery flow upon the treated aneurysm neck and the close proximity of a vortex tube to the parent artery wall increase the maximum wall shear stresses to values approximately equal to 50 Pa at systole. Calculation of the time-averaged wall shear stresses indicates that there is a 1.4 × 9 10−7 m2 area on the parent artery exposed to wall shear stresses greater than 37.9 Pa, a value shown by Fry [Circ. Res. 22(2):165–197, 1968] to cause severe damage to the endothelial cells that line the artery wall. The results of this study demonstrate that it is possible for a treatment procedure, which successfully isolates the aneurysm from the circulation and leaves no aneurysm neck remnant, to elevate the hemodynamic stresses to levels that are injurious to the artery wall. PMID:18629647

  5. What You Should Know about Cerebral Aneurysms

    MedlinePlus

    ... About Stroke What You Should Know About Cerebral Aneurysms Updated:Jun 13,2014 About Cerebral Aneurysms Diagnosis ... to view an animation What is a cerebral aneurysm? An aneurysm is a weak area in a ...

  6. Call-fleming syndrome (reversible cerebral artery vasoconstriction) and aneurysm associated with multiple recreational drug use.

    PubMed

    Drazin, Doniel; Alexander, Michael J

    2013-01-01

    Drug abuse represents a significant health issue. Evidence suggests that recreational drug use has a direct effect on the cerebral vasculature and is of greater concern in those with undiagnosed aneurysms or vascular malformations. The authors report a case of thunderclap headache with a negative head CT and equivocal lumbar puncture after a drug-fueled weekend. The patient underwent diagnostic cerebral angiogram which demonstrated multisegmental, distal areas of focal narrowing of the middle, anterior, posterior, and posterior inferior cerebral artery and an incidental aneurysm. It is often difficult to determine the exact origin of symptoms; thus we were left with a bit of a chicken or the egg debate, trying to decipher which part came first. Either the aneurysm ruptured with associated concomitant vasospasm or it is a case of Call-Fleming syndrome (reversible cerebral artery vasoconstriction) with an incidental aneurysm. The authors proposed their management and rationale of this complex case.

  7. Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease.

    PubMed

    Daou, Badih; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Rosenwasser, Robert H; Jabbour, Pascal

    2015-10-01

    We report a woman who presented with an intraparenchymal hemorrhage. Her cerebral angiogram showed a middle cerebral artery (MCA) M1 occlusion with multiple collaterals supplying the distal MCA territory, compatible with moyamoya disease. Also, an associated 8 mm dysplastic distal aneurysm fed by a left-sided P2 perforator was seen, collateral from the posterior cerebral artery. The aneurysm was successfully occluded with Onyx (ev3 Endovascular, Plymouth, MN, USA) embolization. The woman had an uneventful postoperative course. Aneurysm formation in patients with moyamoya disease represents a major hemorrhagic risk. Several treatment strategies exist including endovascular and surgical approaches. Patients with moyamoya disease who present with aneurysmal intracerebral hemorrhage should be treated to prevent rebleeding. Onyx embolization can be an effective treatment of aneurysms that are associated with moyamoya disease and would otherwise be difficult to treat surgically.

  8. Intraaneurysmal embolization of an unruptured basilar tip aneurysm associated with moyamoya disease.

    PubMed

    Kagawa, K; Ezura, M; Shirane, R; Takahashi, A; Yoshimoto, T

    2001-09-01

    We describe a patient with moyamoya disease associated with an unruptured basilar tip aneurysm which was treated by endovascular embolization using Guglielmi detachable coils (GDCs). A 53-year-old man presented with left hemiparesis persisting for 3 mon ths before admission. Cerebral angiography revealed occlusion of the bilateral middle cerebral arteries and the left anterior cerebral artery, stenosis of the right anterior cerebral artery, and basal moyamoya vessels. In addition, a saccular small aneurysm was seen at the top of the basilar artery. The aneurysm was completely embolized by intraaneurysmal GDCs. Direct surgical clipping is often selected for the treatment of posterior fossa aneurysms in moyamoya disease. However, complete clipping is usually difficult due to the difficulties in operative technique associated with moyamoya disease. We suggest that the endovascular treatment using GDCs is comparatively safe and effective for the treatment of surgically difficult aneurysms in patients with moyamoya disease.

  9. Delayed exacerbation of third nerve palsy due to aneurysmal regrowth after endovascular coil embolization.

    PubMed

    Bhatti, M Tariq; Peters, Keith R; Firment, Christopher; Mericle, Robert A

    2004-03-01

    A 72-year-old woman with a painful left third cranial nerve palsy due to a basilar artery aneurysm situated between the superior cerebellar and posterior cerebral arteries was treated with Guglielmi detachable coils (GDCs). Despite a good initial angiographic result with a small residual neck and improvement in the ocular motility and pain, the patient experienced worsening of the third cranial nerve palsy 15 months later. Cerebral angiography confirmed coil compaction with aneurysmal regrowth. A second endovascular coil embolization resulted in complete obliteration of the aneurysm. The patient experienced complete resolution of the pain and partial resolution of the third cranial nerve palsy. In some patients, a small residual aneurysm neck after endovascular embolization therapy with GDCs can result in delayed aneurysmal regrowth due to coil compaction. Clinical manifestations may herald this dangerous regrowth.

  10. A p1 aneurysm and diabetes insipidus caused by traumatic brain injury.

    PubMed

    Lv, M; Lv, X; Jiang, C; Wu, Z

    2010-12-01

    We describe a patient with a P1 aneurysm of the posterior cerebral artery (PCA) with diabetes insipidus (DI) caused by traumatic brain injury. A 21-year-old woman presented with epidural hematoma, left temporal contusion and subarachnoid hemorrhage caused by head trauma. DI occurred with normal anterior hypophyseal function on the second day after admission and cerebral angiography demonstrated an aneurysm at the right P1 portion after one month. DI was treated with administration of desmopressin and the aneurysm and P1 portion of the right PCA were occluded completely. After three months, her DI recovered and decompressin was discontinued. The six month follow-up angiogram confirmed cure of the P1 aneurysm. P1 aneurysm and DI can be caused by traumatic brain injury. Cranial DI caused by head injury with perturbations in water balance may be transitory and resolve.

  11. Mycotic Aneurysm of the Popliteal Artery Secondary to Enterococcus Endo-carditis : a Case Report.

    PubMed

    Yogeswaran, S K; Stabel, P; Avet, J; Daenen, G

    2014-01-01

    A mycotic popliteal aneurysm (MAAP) is a very rare condition [1]. We describe a 87-year-old Caucasian male who presented with a MAAP of the right leg due to an enterococcus mitral valve endocarditis. The aneurysm was excised and a reversed vein graft was interposed between the normal popliteal artery and the posterior tibial artery. A second vein graft was interposed between the first graft and the anterior tibial artery.

  12. [Splenic artery aneurysms].

    PubMed

    Colović, R; Davidović, L; Bilanović, D; Krivokapić, Z; Grubor, N; Cvetković, S; Radak, V; Marković, M

    2006-01-01

    Although the third most frequent aneurysm in the abdomen, after aneurysms of the aorta and iliac arteries, and most frequent aneurisms of visceral arteries, splenic artery aneurysms are rare, but not very rare. Thanks to the new imaging techniques, first of all ultrasonography, they have been discovered with increasing frequency. We present a series of 9 splenic artery aneurysms. Seven patients were female and two male of average age 49 years (ranging from 28 to 75 years). The majority of afected women were multiparae, with average 3 children (ranging from 1 to 6). One patient had a subacute rupture, and 2 had ruptures into the splenic vein causing portal hypertension. The spleen was enlarged in 7 out of 9 patients. The average size of aneurysms was 3,2 cm (ranging from 2 to 8 cm). The preoperative diagnosis of splenic artery aneurysm was established in 6 patients while in 3 patients aneurism was accidentally found during other operations, during splenectomy in 2, and during the excision of a retroperitoneal tumour in 1 patient. Aneurysmectomy was carried out in 7 patients, while a ligation of the incoming and outcoming wessels was performed in 2 patients with arteriovenous fistula. Splenectomy was performed in 6 patients, while pancreatic tail resection, cholecystectomy and excision of the retroperitoneal tumor were performed in 3 patients. Additional resection of the abdominal aortic aneurysm with reconstruction of aortoiliac segment was performed in 2 patients. There were no mortality and the postoperative recovery was uneventful in all patients. PMID:16989145

  13. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    PubMed

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  14. Pediatric cerebral aneurysms.

    PubMed

    Gemmete, Joseph J; Toma, Ahmed K; Davagnanam, Indran; Robertson, Fergus; Brew, Stefan

    2013-11-01

    Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented.

  15. Hemodynamics of Cerebral Aneurysms

    PubMed Central

    Sforza, Daniel M.; Putman, Christopher M.; Cebral, Juan Raul

    2009-01-01

    The initiation and progression of cerebral aneurysms are degenerative processes of the arterial wall driven by a complex interaction of biological and hemodynamic factors. Endothelial cells on the artery wall respond physiologically to blood-flow patterns. In normal conditions, these responses are associated with nonpathological tissue remodeling and adaptation. The combination of abnormal blood patterns and genetics predisposition could lead to the pathological formation of aneurysms. Here, we review recent progress on the basic mechanisms of aneurysm formation and evolution, with a focus on the role of hemodynamic patterns. PMID:19784385

  16. Postoperative subarachnoid hemorrhage from an intracranial aneurysm after craniotomy for astrocytoma--case report.

    PubMed

    Yamada, H; Taomoto, K

    1989-09-01

    The authors present the first reported case of a glioma associated with a right posterior cerebral artery (PCA) aneurysm. A 37-year-old male underwent craniotomy and total removal of the glioma, which appeared, according to encephalographic findings, to be responsible for the initial symptom of loss of consciousness. The risk of craniotomy-induced bleeding from the aneurysm was thought to be low, since it was unruptured and was packed with coagulum. However, subarachnoid hemorrhage due to rupture of the PCA aneurysm occurred just after craniotomy, and clipping was performed 15 days after the first operation. PMID:2480546

  17. Intrasplenic Arterial Aneurysms during Pregnancy

    PubMed Central

    Abu-khalaf, Mahmoud M. S.; Al-Ameer, Sokiyna M.; Smadi, Moath M.; Qatawneh, Ayman; Smara, Osama A.; Hadidy, Azmy T.

    2015-01-01

    Splenic artery aneurysms account for about 60% of all visceral aneurysms. Pregnancy is a risk factor for splenic artery aneurysms rupture with high maternal mortality and fetal loss. Intrasplenic arterial aneurysms are extremely rare and have not been reported to be associated with pregnancy. This report presents a 34-year-old woman during the second trimester, admitted with severe left upper quadrant and left shoulder pain. She had two uncomplicated intrasplenic aneurysms. Splenectomy was done. She delivered a full term healthy girl. This is the first report of acute abdomen during pregnancy caused by intrasplenic artery aneurysms with maternal and fetal survival. PMID:25810934

  18. Optical coherence tomography: a new method to assess aneurysm healing

    PubMed Central

    Thorell, William E.; Chow, Michael M.; Prayson, Richard A.; Shure, Mark A.; Jeon, Sung W.; Huang, David; Zeynalov, Emil; Woo, Henry H.; Rasmussen, Peter A.; Rollins, Andrew M.; Masaryk, Thomas J.

    2007-01-01

    Object Aneurysmal subarachnoid hemorrhage affects approximately 10/100,000 people per year. Endovascular coil embolization is used increasingly to treat cerebral aneurysms and its safety and durability is rapidly developing. The long-term durability of coil embolization of cerebral aneurysms remains in question; patients treated using this modality require multiple follow-up angiography studies and occasional repeated treatments. Methods Optical coherence tomography (OCT) is an emerging imaging modality that uses backscattered light to produce high-resolution tomography of optically accessible biological tissues such as the eye, luminal surface of blood vessels, and gastrointestinal tract. Vascular OCT probes in the form of imaging microwires are presently available—although not Food and Drug Administration–approved—and may be adapted for use in the cerebral circulation. In this study the authors describe the initial use of OCT to make visible the neck of aneurysms created in a canine model and treated with coil embolization. Optical coherence tomography images demonstrate changes that correlate with the histological findings of healing at the aneurysm neck and thus may be capable of demonstrating human cerebral aneurysm healing. Conclusions Optical coherence tomography may obviate the need for subsequent follow-up angiography studies as well as aid in the understanding of endovascular tissue healing. Data in this study demonstrate that further investigation of in vivo imaging with such probes is warranted. PMID:15739565

  19. Surgical options for the management of visceral artery aneurysms.

    PubMed

    Van Petersen, A; Meerwaldt, R; Geelkerken, R; Zeebregts, C

    2011-06-01

    Visceral artery aneurysm (VAA) is a rare entity but increased use of abdominal imaging has led to an increased prevalence. Rupture is related to a high mortality rate. Open repair, endovascular treatment and laparoscopic techniques have been described as treatment options. In this systematic review we describe the surgical options for treating VAA. A literature search identified articles focussing on the key issues of visceral artery aneurysms and surgical options using the Pubmed and Cochrane databases. Case reports dominate the literature about VAA. Twenty-seven small case series and ten review articles have been published in the last 20 years concerning the surgical options for VAA. The evidence does not exceed level 3. Surgical treatment is dictated by both patient and aneurysm characteristics. Whether VAA should be treated largely depends upon age, gender, presence of hypertension (e.g. in renal aneurysm), aneurysm size and presentation. Aneurysm size and characteristics, anatomical location and presence of collateral circulation dictate the surgical option to be chosen. The mortality and morbidity rates after elective open repair are low. Literature about surgical options for treating VAA remains scarce. Only a few clinical trials have shown the possibilities and results of open surgical repair. In general, there is no consensus on the surgical treatment of VAA and the highest level of evidence is based upon expert opinions. PMID:21577188

  20. Surgical options for the management of visceral artery aneurysms.

    PubMed

    Van Petersen, A; Meerwaldt, R; Geelkerken, R; Zeebregts, C

    2011-06-01

    Visceral artery aneurysm (VAA) is a rare entity but increased use of abdominal imaging has led to an increased prevalence. Rupture is related to a high mortality rate. Open repair, endovascular treatment and laparoscopic techniques have been described as treatment options. In this systematic review we describe the surgical options for treating VAA. A literature search identified articles focussing on the key issues of visceral artery aneurysms and surgical options using the Pubmed and Cochrane databases. Case reports dominate the literature about VAA. Twenty-seven small case series and ten review articles have been published in the last 20 years concerning the surgical options for VAA. The evidence does not exceed level 3. Surgical treatment is dictated by both patient and aneurysm characteristics. Whether VAA should be treated largely depends upon age, gender, presence of hypertension (e.g. in renal aneurysm), aneurysm size and presentation. Aneurysm size and characteristics, anatomical location and presence of collateral circulation dictate the surgical option to be chosen. The mortality and morbidity rates after elective open repair are low. Literature about surgical options for treating VAA remains scarce. Only a few clinical trials have shown the possibilities and results of open surgical repair. In general, there is no consensus on the surgical treatment of VAA and the highest level of evidence is based upon expert opinions.

  1. Technical challenges to surgical clipping of aneurysmal regrowth with coil herniation following endovascular treatment – a case report

    PubMed Central

    Pillai, Promod; Karim, Aftab; Nanda, Anil

    2007-01-01

    In recent years, technical developments have made endovascular procedures attractive therapeutic options and enabled the endovascular surgeon to redefine the management of cerebral aneurysms. However, as the number of aneurysms undergoing endovascular therapy has grown, so has the number of patients with incompletely treated aneurysms who are presenting for further management. In cases of failure of endovascular treatment caused by either incomplete occlusion or regrowth of the aneurysm, a complementary treatment is often necessary. Surgical treatment of these patients is challenging. We present a case of a ruptured posterior cerebral artery aneurysm treated initially with endovascular coiling that left behind significant residual aneurysmal sac. Regrowth of the aneurysm documented on follow-up was treated surgically. At surgery, the coil was found to have herniated through the aneurysmal sac into the subarachnoid space, and the aneurysm was successfully clipped without removing the coils. We review the regrowth of aneurysms following endovascular therapy and potential problems and challenges of surgically managing these lesions. PMID:18053204

  2. Newtonian and non-Newtonian blood flow in coiled cerebral aneurysms.

    PubMed

    Morales, Hernán G; Larrabide, Ignacio; Geers, Arjan J; Aguilar, Martha L; Frangi, Alejandro F

    2013-09-01

    Endovascular coiling aims to isolate the aneurysm from blood circulation by altering hemodynamics inside the aneurysm and triggering blood coagulation. Computational fluid dynamics (CFD) techniques have the potential to predict the post-operative hemodynamics and to investigate the complex interaction between blood flow and coils. The purpose of this work is to study the influence of blood viscosity on hemodynamics in coiled aneurysms. Three image-based aneurysm models were used. Each case was virtually coiled with a packing density of around 30%. CFD simulations were performed in coiled and untreated aneurysm geometries using a Newtonian and a Non-Newtonian fluid models. Newtonian fluid slightly overestimates the intra-aneurysmal velocity inside the aneurysm before and after coiling. There were numerical differences between fluid models on velocity magnitudes in coiled simulations. Moreover, the non-Newtonian fluid model produces high viscosity (>0.007 [Pas]) at aneurysm fundus after coiling. Nonetheless, these local differences and high-viscous regions were not sufficient to alter the main flow patterns and velocity magnitudes before and after coiling. To evaluate the influence of coiling on intra-aneurysmal hemodynamics, the assumption of a Newtonian fluid can be used. PMID:23891312

  3. Computational hemodynamic study of intracranial aneurysms coexistent with proximal artery stenosis

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Peloc, Nora L.; Putman, Christopher M.; Cebral, Juan R.

    2012-03-01

    Intracranial aneurysms and artery stenosis are vascular diseases with different pathophysiological characteristics. However, although unusual, aneurysms may coexist in up to 5% of patients with stenotic plaque, according to a previous study. Another study showed that incidental detection of cerebral aneurysm in the same cerebral circulation as the stenotic plaque was less than 2%. Patients with concomitant carotid artery stenosis and unruptured intracranial aneurysms pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The purpose of this study is to investigate the intraaneurysmal hemodynamic changes before and after treatment of stenotic plaque. Idealized models were constructed with different stenotic grade, distance and relative position to the aneurysm. Digital removal of the stenotic plaque was performed in the reconstructed model of a patient with both pathologies. Computational fluid dynamic simulations were performed using a finite element method approach. Blood velocity field and hemodynamic forces were recorded and analyzed. Changes in the flow patterns and wall shear stress values and distributions were observed in both ideal and image-based models. Detailed investigation of wall shear stress distributions in patients with both pathologies is required to make the best management decision.

  4. Computational study of anterior communicating artery hemodynamics before aneurysm formation

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2012-03-01

    It is widely accepted that complexity in the flow pattern at the anterior communicating artery (AComA) is associated with the high rate of aneurysm formation in that location observed in large studies. A previous computational hemodynamic study showed a possible association between high maximum intraaneurysmal wall shear stress (WSS) at the systolic peak with rupture in a cohort of AComA aneurysms. In another study it was observed a connection between location of aneurysm blebs and regions of high WSS in models where blebs were virtually removed. However, others reported associations between low WSS and either rupture or blister formation. The purpose of this work is to study associations between hemodynamic patterns and AComA aneurysm initiation by comparing hemodynamics in the aneurysm and the normal model where the aneurysm was computationally removed. Vascular models of both right and left circulation were independently reconstructed from three-dimensional rotational angiography images using deformable models, and fused using a surface merging algorithm. The geometric models were then used to generate high-quality volumetric finite element grids of tetrahedra with an advancing front technique. For each patient, the second anatomical model was created by digitally removing the aneurysm. It was iteratively achieved by applying a Laplacian smoothing filter and remeshing the surface. Finite element blood flow numerical simulations were performed. It was observed that aneurysms initiated in regions of high and moderate WSS in the counterpart normal models. Adjacent or close to those regions, low WSS portions of the arterial wall were not affected by the disease.

  5. Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.

    PubMed

    Lansen, T A; Kasoff, S S; Arguelles, J H

    1989-07-01

    Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

  6. A Critical Role for Proinflammatory Behavior of Smooth Muscle Cells in Hemodynamic Initiation of Intracranial Aneurysm

    PubMed Central

    Mandelbaum, Max; Kolega, John; Dolan, Jennifer M.; Siddiqui, Adnan H.; Meng, Hui

    2013-01-01

    Background Intracranial aneurysm initiation is poorly understood, although hemodynamic insult is believed to play an important role in triggering the pathology. It has recently been found in a rabbit model that while macrophages are absent during hemodynamic aneurysm initiation, matrix metalloproteinases (MMPs) are elevated and co-localize with smooth muscle cells (SMCs). This study investigates whether SMCs play a mechanistic role in aneurysm initiation triggered by hemodynamics. Methods Aneurysmal damage was induced at the basilar terminus via bilateral common carotid artery ligation in rabbits (n = 45, plus 7 sham controls). 16 ligated rabbits were treated with doxycycline to inhibit MMPs, 7 received clodronate liposomes to deplete circulating monocytes, and the rest received no drug. Effects of the treatments on aneurysm development were assessed histologically 5 days and 6 months after ligation. MMP production and expression of inflammatory markers by SMCs was monitored by immunohistochemistry and in situ hybridization. Results Treatment with doxycycline attenuated aneurysmal development examined at 5 days and 6 months, suggesting that MMPs contribute to aneurysm initiation. However, systemic depletion of macrophages did not decrease MMPs or suppress aneurysmal development. Immunofluorescence showed that during aneurysm initiation MMP-2 and MMP-9 were distributed in SMCs, and in situ hybridization indicated that they were transcribed by SMCs. In regions of early aneurysmal lesion, SMCs exhibited decreased expression of smooth muscle actin and increased NF-κB and MCP-1 expressions. Conclusions During aneurysm initiation triggered by hemodynamics, SMCs rather than macrophages are responsible for MMP production that is critical for aneurysmal lesion development. These SMCs exhibit proinflammatory behavior. PMID:24023941

  7. Carotid siphon geometry and variants of the circle of Willis in the origin of carotid aneurysms.

    PubMed

    Silva Neto, Ângelo Raimundo; Câmara, Ródio Luis Brandão; Valença, Marcelo Moraes

    2012-12-01

    This study evaluated anatomical variants in the carotid siphon and of the circle of Willis in patients with aneurysms. We performed a retrospective analysis of cerebral angiographies. The Control Group was composed of patients without aneurysms. Posterior communicating artery (PcomA) aneurysms were more common in women (p<0.05), and the anterior communicating artery (AcomA) aneurysms in men (p<0.1). The incidence of fetal-type PcomA was higher in cases with co-occurring PcomA aneurysm (24 versus 8%, p<0.05). Patients with AcomA aneurysm had higher incidence of A1 hypoplasia (p<0.0001, OR=32.13, 95%CI 12.95-79.71) and lower frequency of fetal-type PcomA compared to their control counterparts (p=0.0125). The angle of carotid siphon was narrower in patients with PcomA aneurysm (27.3±19.1 versus 34.8±22.6, p=0.028). In conclusion, a narrower carotid siphon or the presence of fetal-type PcomA or A1 hypoplasia may cause hemodynamic stress, thereby promoting the formation of aneurysms in susceptible individuals.

  8. Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils.

    PubMed

    Gobin, Y P; Viñuela, F; Gurian, J H; Guglielmi, G; Duckwiler, G R; Massoud, T F; Martin, N A

    1996-01-01

    Results in nine patients with large or giant fusiform intracranial aneurysms that were treated with Guglielmi detachable coils (GDCs) are reported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic and located in an arterial feeder of an arteriovenous malformation. Five aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preservation of the parent artery was attempted in three cases, and complete occlusion of the aneurysm and the parent artery was performed in six patients. The tolerance to parent artery occlusion was assessed by angiography, balloon test occlusion, and amytal testing. Six aneurysms were permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with SAH made an excellent clinical recovery. Three of the four patients presenting with mass effect recovered completely and one remained unchanged. The patient with an incidental aneurysm remained asymptomatic. There were no permanent complications. In conclusion, GDCs were useful for the occlusion of large and giant intradural fusiform aneurysms. Occlusion of the aneurysm and the parent artery afforded the greatest opportunity for a complete cure. Advantages of GDCs compared to balloons include: occlusion of a shorter segment of normal artery, no traction on the parent vessel, and safer and easier catheterization techniques.

  9. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  10. Rasmussen's aneurysm: A forgotten scourge☆

    PubMed Central

    Chatterjee, Kshitij; Colaco, Brendon; Colaco, Clinton; Hellman, Michael; Meena, Nikhil

    2015-01-01

    Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary artery adjacent to a tuberculous cavity. Life threatening massive hemoptysis from the rupture of a Rasmussen's aneurysm is an uncommon yet life threatening complication of cavitary tuberculosis (TB). We present a case of a young woman who presented with low-grade fever and hemoptysis. Computed tomographic (CT) angiography showed biapical cavitary lesions and actively bleeding aneurysms involving pulmonary artery, which successfully underwent glue embolization. PMID:26744661

  11. Subarachnoid hemorrhage caused by a ruptured anterior spinal artery aneurysm.

    PubMed

    Karakama, Jun; Nakagawa, Kazuhiko; Maehara, Taketoshi; Ohno, Kikuo

    2010-01-01

    A 51-year-old man presented with an extremely rare case of intracranial subarachnoid hemorrhage caused by rupture of an anterior spinal artery aneurysm manifesting as disturbance of consciousness following sudden onset of neck pain and numbness of the extremities. Cranial computed tomography revealed subarachnoid hemorrhage, mainly in the posterior fossa. Cerebral angiography studies on admission and on the 4th day demonstrated no definite abnormality as a bleeding source. A ventricular catheter was inserted to treat the acute hydrocephalus, and conservative management was continued during the acute period. Third angiography on the 18th day demonstrated an anterior spinal artery aneurysm at the C1 level which was considered to be the bleeding site. After conservative treatment, the patient was discharged without neurological deficits. Fourth angiography on the 108 th day disclosed spontaneous disappearance of the aneurysm, which was confirmed by the fifth angiography on the 269 th day. If subarachnoid hemorrhage of unknown etiology is encountered, spinal artery aneurysm should be considered as the bleeding source. Despite the controversy concerning the treatment strategy, ruptured spinal artery aneurysms can be treated conservatively because of the possibility of spontaneous regression. Follow-up angiography is required to evaluate the natural course of the lesion.

  12. How Is an Aneurysm Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is an Aneurysm Diagnosed? If you have an aortic aneurysm but no symptoms, your doctor may find it ... a routine physical exam. More often, doctors find aneurysms during tests done for other reasons, such as ...

  13. Unruptured Intracranial Aneurysms:

    PubMed Central

    Raymond, J.; Nguyen, T.; Chagnon, M.; Gevry, G.

    2007-01-01

    'if a man will begin with certainties, he shall end in doubts; 'but if he will be content to begin with doubts he shall end in certainties'. Sir Francis Bacon, The Advancement of Learning Summary In the absence of level one evidence, the treatment of unruptured intracranial aneurysms is grounded on opinions. Results of the largest registry available, ISUIA (the International Study on Unruptured Intraacranial Aneurysms) suggest that surgical or endovascular treatments are rarely justified. Yet the unruptured aneurysm is the most frequent indication for treatment in many endovascular centres. In preparation for the initiation of a randomized trial, we aimed at a better knowledge of endovascular expert opinions on unruptured aneurysms. We administered a standard questionnaire to 175 endovascular experts gathered at the WFITN meeting in Val d'lsère in 2007. Four paradigm unruptured aneurysms were used to poll opinions on risks of treatment or observation, as well as on their willingness to treat, observe or propose to the patient participation in a randomized trial, using six questions for each aneurysm. Opinions varied widely among lesions and among participants. Most participants (92.5%) were consistent, as they would offer treatment only if their estimate of the ten-year risk of spontaneous hemorrhage would exceed risks of treatment. Estimates of the natural history were consistently higher than that reported by ISUIA. Conversely, treatment risks were underestimated compared to those reported in ISUIA, but within the range reported in a recent French registry (ATENA). Participants were more confident in their evaluation of treatment risks and in their skills at treating aneurysms than in their estimates of risks of rupture entailed by the presence of the lesion, the latter being anchored at or close to 1% /year. The gulf between expert opinions, clinical practices and available data from registries persist. Expert opinions are compatible with the primary hypothesis

  14. Surrogate Markers of Abdominal Aortic Aneurysm Progression.

    PubMed

    Wanhainen, Anders; Mani, Kevin; Golledge, Jonathan

    2016-02-01

    The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Standardized reporting of reproducible methods of measuring AAA diameter is essential. Newer imaging assessments, such as volume measurements, biomechanical analyses, and functional and molecular imaging, as well as circulating biomarkers, have potential to add important information about AAA progression. Currently, however, there is insufficient evidence to recommend their routine use in clinical practice. PMID:26715680

  15. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  16. [Syphilitic aortic aneurysm. A case report].

    PubMed

    Ben Halima, A; Ibn Elhadj, Z; Essmat, W; Léfi, A; Kammoun, I; Zouaoui, W; Marrakchi, S; Chine, S; Gargouri, S; Keskes, H; Kachboura, S

    2006-05-01

    The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.

  17. Aberrant right subclavian artery and calcified aneurysm of kommerell's diverticulum: an alternative approach

    PubMed Central

    Alvarez, Jose Rubio J; Quiroga, Sierra JL; Nazar, Adrio B; Comendador, Martinez JM; Carro, Garcia J

    2008-01-01

    We report a 72 year-old man with dysphagia and dizziness. Aortography and Computed tomographic scans revealed the aberrant right subclavian artery arising from a calcified aneurysm of the Kommerell's diverticulum and bilateral carotid artery disease with atherosclerotic narrowing. Surgical relief was accomplished by excluding the aneurysm from circulation through the aortic arch and a 10 mm graft was interposed between the aberrant artery and the ascending aorta. PMID:18613969

  18. Novel role for endogenous hepatocyte growth factor in the pathogenesis of intracranial aneurysms.

    PubMed

    Peña-Silva, Ricardo A; Chalouhi, Nohra; Wegman-Points, Lauren; Ali, Muhammad; Mitchell, Ian; Pierce, Gary L; Chu, Yi; Ballas, Zuhair K; Heistad, Donald; Hasan, David

    2015-03-01

    Inflammation plays a key role in formation and rupture of intracranial aneurysms. Because hepatocyte growth factor (HGF) protects against vascular inflammation, we sought to assess the role of endogenous HGF in the pathogenesis of intracranial aneurysms. Circulating HGF concentrations in blood samples drawn from the lumen of human intracranial aneurysms or femoral arteries were compared in 16 patients. Tissue from superficial temporal arteries and ruptured or unruptured intracranial aneurysms collected from patients undergoing clipping (n=10) were immunostained with antibodies to HGF and its receptor c-Met. Intracranial aneurysms were induced in mice treated with PF-04217903 (a c-Met antagonist) or vehicle. Expression of inflammatory molecules was also measured in cultured human endothelial, smooth muscle cells and monocytes treated with lipopolysaccharides in presence or absence of HGF and PF-04217903. We found that HGF concentrations were significantly higher in blood collected from human intracranial aneurysms (1076±656 pg/mL) than in femoral arteries (196±436 pg/mL; P<0.001). HGF and c-Met were detected by immunostaining in superficial temporal arteries and in both ruptured and unruptured human intracranial aneurysms. A c-Met antagonist did not alter the formation of intracranial aneurysms (P>0.05), but significantly increased the prevalence of subarachnoid hemorrhage and decreased survival in mice (P<0.05). HGF attenuated expression of vascular cell adhesion molecule-1 (P<0.05) and E-Selectin (P<0.05) in human aortic endothelial cells. In conclusion, plasma HGF concentrations are elevated in intracranial aneurysms. HGF and c-Met are expressed in superficial temporal arteries and in intracranial aneurysms. HGF signaling through c-Met may decrease inflammation in endothelial cells and protect against intracranial aneurysm rupture. PMID:25510828

  19. Combined Endovascular and Microsurgical Procedures as Complementary Approaches in the Treatment of a Single Intracranial Aneurysm

    PubMed Central

    Lim, Yong Cheol; Chung, Joonho

    2008-01-01

    Objective Both endovascular coil embolization and microsurgical clipping are now firmly established as treatment options for the management of cerebral aneurysms. Moreover, they are sometimes used as complementary approaches each other. This study retrospectively analyzed our experience with endovascular and microsurgical procedures as complementary approaches in treating a single aneurysm. Methods Nineteen patients with intracranial aneurysm were managed with both endovascular and microsurgical treatments. All of the aneurysms were located in the anterior circulation. Eighteen patients presented with SAH, and 14 aneurysms had diameters of less than 10 mm, and five had diameters of 10-25 mm. Results Thirteen of the 19 patients were initially treated with endovascular coil embolization, followed by microsurgical management. Of the 13 patients, 9 patients had intraprocedural complications during coil embolization (intraprocedural rupture, coil protrusion, coil migration), rebleeding with regrowth of aneurysm in two patients, residual sac in one patient, and coil compaction in one patient. Six patients who had undergone microsurgical clipping were followed by coil embolization because of a residual aneurysm sac in four patients, and regrowth in two patients. Conclusion In intracranial aneurysms involving procedural endovascular complications or incomplete coil embolization and failed microsurgical clipping, because of anatomical and/or technical difficulties, the combined and complementary therapy with endovascular coiling and microsurgical clipping are valuable in providing the best outcome. PMID:19096540

  20. Pediatric intracranial aneurysms.

    PubMed

    Tripathy, L N; Singh, S N

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult counterparts. We present four such cases from our own experience. All these children were operated upon, where the solitary aneurysm in each case was clipped and all of them made a good recovery.

  1. Endovascular aortic aneurysm operations.

    PubMed

    Najibi, Sasan; Terramani, Thomas T; Weiss, Victor J; Smith, Robert B; Salam, Atef A; Dodson, Thomas F; Chaikof, Elliot L; Lumsden, Alan B

    2002-02-01

    Options for the treatment of abdominal and thoracic aortic aneurysms are in a state of evolutionary change. The development and continued refinement of the endoluminal approaches has decreased the need for open aortic aneurysm surgery. Endovascular stent graft technology is an area of active research in which both the delivery systems and the endografts are undergoing continued improvement so that patients with what was previously thought to be unfavorable anatomy may be treated by these means. The design and deployment techniques of the currently available endografts, as well as those in clinical trials, are presented. PMID:11822962

  2. Parallel multiscale simulations of a brain aneurysm

    NASA Astrophysics Data System (ADS)

    Grinberg, Leopold; Fedosov, Dmitry A.; Karniadakis, George Em

    2013-07-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multiscale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier-Stokes solver NɛκTαr. The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers (NɛκTαr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300 K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in future

  3. Parallel multiscale simulations of a brain aneurysm

    SciTech Connect

    Grinberg, Leopold; Fedosov, Dmitry A.; Karniadakis, George Em

    2013-07-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multiscale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier–Stokes solver NεκTαr. The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers (NεκTαr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300 K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in

  4. Ruptured cerebral fusiform aneurysm with mucopolysaccharide deposits in the tunica media in a patient with Marfan syndrome.

    PubMed

    Kubo, Yoshitaka; Ogasawara, Kuniaki; Kurose, Akira; Kakino, Shunsuke; Tomitsuka, Nobuhiko; Ogawa, Akira

    2009-03-01

    Although aortic or cardiac complications are common in patients with Marfan syndrome, the presence of an intracranial aneurysm is comparatively rare. In this study, the authors report on their experience with resection of a ruptured fusiform aneurysm of the posterior cerebral artery in a 30-year-old woman with Marfan syndrome. Microscopic examination of the resected tissue showed many Alcian blue-staining deposits, consistent with the presence of mucopolysaccharide in the tunica media and focal fragmentation of the internal elastic lamina.

  5. Intracranial Stenting in the Treatment of Wide-Necked Aneurysms

    PubMed Central

    Leonardi, M.; Dall'olio, M.; Cenni, P.; Raffi, L.; Simonetti, L.

    2007-01-01

    Summary We positioned the following self-expanding stents certified for intracranial application: 16 Neuro form (Boston Scientific), three INX (Medtronic), one Leo (Balt). 6F calibre femoral introducers and guiding catheters were used for stent placement changing to 5F calibre introducers and guiding catheters (Envoy, Cordis) for the Neuroform 2 and 3 stents. All procedures were carried out under general anaesthesia and heparinization. Our pharmacological protocol consisted of adjunctive treatment with anti-aggregants during the interventional procedure and for the following six months, without premedication. From November 2000 to August 2006 we treated 28 patients (27 F/1M) with giant wide-necked aneurysms and one dissecting basilar artery aneurysm requiring the placement of 29 stents. We successfully positioned 20 stents: 11 stents combined with coils (8 immediate; 3 late) with complete exclusion of the aneurysm from the circulation in seven cases and subtotal exclusion in four; nine stents not followed by embolization with complete exclusion of the aneurysm from the circulation in six cases and subtotal exclusion in three. Stenting was not possible in nine cases due to extreme vessel tortuosity and the poor flexibility of release systems for the first stents. No late stent occlusion or subarachnoid haemorrhage were encountered after treatment. PMID:20566126

  6. Posterior malleolus fracture.

    PubMed

    Irwin, Todd A; Lien, John; Kadakia, Anish R

    2013-01-01

    Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, such as restoring articular congruity and rotatory ankle stability, as well as preventing posterior talar translation, but current indications are unclear. Fragment size as a percentage of the anteroposterior dimension of the articular surface is often cited as an indication for fixation, although several factors may contribute to the decision, such as articular impaction, comminution, and syndesmotic stability. Outcome studies show that, in patients with ankle fractures, the presence of a posterior malleolus fracture negatively affects prognosis. Notable variability is evident in surgeon practice. PMID:23281469

  7. Familial abdominal aortic aneurysm: prevalence and implications for screening.

    PubMed

    Adams, D C; Tulloh, B R; Galloway, S W; Shaw, E; Tulloh, A J; Poskitt, K R

    1993-11-01

    The high prevalence of abdominal aortic aneurysm (AAA) in men over the age of 65 has led to the establishment of ultrasound screening programmes for this group. The apparent familial tendency towards AAA formation suggests that relatives of aneurysm patients may form another subpopulation in whom screening is appropriate. The first degree relatives of 100 consecutive aneurysm patients were identified. Of 110 relatives over 50 years of age, two were known to have had AAA and ultrasound scans were performed on 74, providing information on aortic size for 76 relatives (69%). No further aortic aneurysms (antero-posterior diameter > or = 4.0 cm) were found on scanning. However, nine relatives were demonstrated to have aortic dilatation (2.5-3.9 cm). Aortic dilatation was observed in 21% of male first degree relatives over 50 years of age, affecting 27% of sons and 17% of brothers. Only 4% of the sisters and none of the daughters were found to have aortic dilatation. The prevalence of aortic enlargement seems to be sufficiently high amongst male first degree relatives of AAA patients over 50 years of age to justify aortic screening.

  8. Surgical Treatment of Aneurysmal Bone Cysts of the Spine

    PubMed Central

    Mesfin, Addisu; McCarthy, Edward F.; Kebaish, Khaled M.

    2012-01-01

    Objective Our goal was to document the presentation, location, diagnostic modalities, preoperative embolization status, treatment, histology, complications, and recurrence rates for aneurysmal bone cysts of the mobile spine. Methods We reviewed our institution's database to identify patients diagnosed with aneurysmal bone cysts of the mobile spine (excluding the sacrum) from 1995 through 2006. Of those 17 patients, three were treated elsewhere and 14 underwent surgical treatment at our institution. Of those 14 patients, the nine (mean age at presentation, 17.2 years; range, 5‥32 years) with at least 2 years of follow-up (average, 49.6 months; range, 24‥88 months) formed our study group. For those nine patients, we tabulated the presentation, location, diagnostic modalities, preoperative embolization status, treatment, histology, complications, and recurrence rates. Results Pain was the presenting symptom in all nine patients. The lesion most commonly occurred in the cervical spine (five); two occurred in the lumbar spine, and two occurred in the thoracic spine. Patients underwent resection and combined anterior and posterior spinal arthrodesis (six) or resection and posterior spinal arthrodesis (three). There were four complications: one iliac crest donor site infection, one incidental durotomy, and two neurologic defcits. We noted two recurrences (both within 3 months). Conclusions Aneurysmal bone cysts of the spine can be successfully treated with surgical resection and instrumentation. PMID:23576920

  9. Idiopathic internal mammary artery aneurysm

    PubMed Central

    Heyn, Jens; Zimmermann, Hanna; Klose, Alexander; Luchting, Benjamin; Hinske, Christian; Sadeghi-Azandaryani, Mojtaba

    2014-01-01

    Aneurysms of the internal mammary artery are extremely rare, and their presentation and treatment are variable. Since these aneurysms often tend to rupture and cause haemothorax and life-threatening conditions, the knowledge of secure treatment options is indispensable. We here report the case of an idiopathic internal mammary aneurysm in a 46-year-old man. Open surgical resection of the aneurysm was performed in this case without any complications. The postoperative course was uneventful and the patient was in a good physical condition without any vascular or neurological abnormalities during follow-up. PMID:25452261

  10. Incidence and Risk Factors for Rebleeding during Cerebral Angiography for Ruptured Intracranial Aneurysms

    PubMed Central

    Lim, Yong Cheol; Kim, Chang-Hyun; Kim, Yong Bae; Joo, Jin-Yang; Shin, Yong Sam

    2015-01-01

    Purpose The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. Materials and Methods Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. Results There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. Conclusion Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA. PMID:25683988

  11. Impact of the volume of aneurysmal contents on intraaneurysmal pressure after endovascular grafting (experimental studies).

    PubMed

    Volodos', S N; Sayers, R D; Bell, P R F; Gostelow, J P

    2005-01-01

    With the purpose of clarifying the nature and outlining certain constituents of such an undesirable condition designated as "endotension", that emerges after transluminal grafting of the aneurysmally changed aorta, a basic theoretical model was worked out for explanation of "endotension". Also, there was designed and constructed in vitro an original experimental model using which the authors carried out a study into the relationship between the pressure in the aneurysm after its complete exclusion from the blood flow by an endovascular graft and the volume of the aneurysmal contents. Some factors described in the literature as influencing the pressure level in the aneurysm were at the given stage purposefully excluded. The volume of the "aneurysm" reproduced in our model was equal to 675 ml; each of five vascular grafts implanted into the aneurysm measured 110 mm in length. The pulsating liquid flow was reproduced in the system using a serial appliance for extracorporeal circulation. The liquid was aspirated from the aneurysm by means of a syringe with concurrent pressure guidance in the sac. To start pressure lowering, it was necessary to evacuate 0.4-1.6 ml of the liquid. The real clinical situations were considered from the standpoint of our results.

  12. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  13. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  14. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  15. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  16. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  17. Isolated spinal artery aneurysm: a rare culprit of subarachnoid haemorrhage.

    PubMed

    Sung, Tony H T; Leung, Warren K W; Lai, Bill M H; Khoo, Jennifer L S

    2015-04-01

    Isolated spinal artery aneurysm is a rare lesion which could be accountable for spontaneous spinal subarachnoid haemorrhage. We describe the case of a 74-year-old man presenting with sudden onset of chest pain radiating to the neck and back, with subsequent headache and confusion. Initial computed tomography aortogram revealed incidental finding of subtle acute spinal subarachnoid haemorrhage. A set of computed tomography scans of the brain showed further acute intracranial subarachnoid haemorrhage with posterior predominance, small amount of intraventricular haemorrhage, and absence of intracranial vascular lesions. Subsequent magnetic resonance imaging demonstrated a thrombosed intradural spinal aneurysm with surrounding sentinel clot, which was trapped and excised during surgical exploration. High level of clinical alertness is required in order not to miss this rare but detrimental entity. Its relevant aetiopathological features and implications for clinical management are discussed.

  18. Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research

    PubMed Central

    Benet, Arnau; Plata-Bello, Julio; Abla, Adib A.; Acevedo-Bolton, Gabriel; Saloner, David; Lawton, Michael T.

    2015-01-01

    Aim. To evaluate the feasibility of implanting 3D-printed brain aneurysm model in human cadavers and to assess their utility in neurosurgical research, complex case management/planning, and operative training. Methods. Two 3D-printed aneurysm models, basilar apex and middle cerebral artery, were generated and implanted in four cadaveric specimens. The aneurysms were implanted at the same anatomical region as the modeled patient. Pterional and orbitozygomatic approaches were done on each specimen. The aneurysm implant, manipulation capabilities, and surgical clipping were evaluated. Results. The 3D aneurysm models were successfully implanted to the cadaveric specimens' arterial circulation in all cases. The features of the neck in terms of flexibility and its relationship with other arterial branches allowed for the practice of surgical maneuvering characteristic to aneurysm clipping. Furthermore, the relationship of the aneurysm dome with the surrounding structures allowed for better understanding of the aneurysmal local mass effect. Noticeably, all of these observations were done in a realistic environment provided by our customized embalming model for neurosurgical simulation. Conclusion. 3D aneurysms models implanted in cadaveric specimens may represent an untapped training method for replicating clip technique; for practicing certain approaches to aneurysms specific to a particular patient; and for improving neurosurgical research. PMID:26539542

  19. Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography.

    PubMed

    Liao, Chih-Hsiang; Lin, Chung-Jung; Lin, Chun-Fu; Huang, Hsin-Yi; Chen, Min-Hsiung; Hsu, Sanford P C; Shih, Yang-Hsin

    2016-08-01

    OBJECTIVE The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA). METHODS Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks. RESULTS Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow

  20. Posterior cerebral artery territory infarctions.

    PubMed

    Cereda, Carlo; Carrera, Emmanuel

    2012-01-01

    Infarctions in the territory of the posterior cerebral artery (PCA) occur in about 5-10% of all ischemic strokes. The PCA can be divided into 'deep' (P1 and P2 segments) and 'superficial' (P3 and P4) segments. Occlusion of paramedian perforating arteries arising from P1 causes rostral midbrain infarction with or without thalamic lesion. The classical clinical triad after thalamomesencephalic infarcts is hypersomnolence, cognitive deficits and vertical oculomotor paresis. Two main arterial groups arise from P2: infarction in the territory of the thalamogeniculate arteries causes severe contralateral hypesthesia and ataxia, whereas infarction in the territory of the posterior choroidal arteries results in sectoranopia with involvement of the lateral geniculate body. After superficial PCA infarcts, visual field defects and somatosensory deficits are the most frequent signs. Additionally, disorders of reading may be seen after unilateral left infarction and disorientation for place and visual neglect after right lesion. After bilateral PCA infarcts, amnesia, cortical blindness (the patient cannot see but pretend he can) may occur. Acute thrombolysis is as useful after PCA infarctions as after anterior circulation strokes. Mortality after PCA strokes is low, but long-term behavioral and cognitive deficits are underestimated.

  1. Experimental unsteady flow study in a patient-specific abdominal aortic aneurysm model

    NASA Astrophysics Data System (ADS)

    Stamatopoulos, Ch.; Mathioulakis, D. S.; Papaharilaou, Y.; Katsamouris, A.

    2011-06-01

    The velocity field in a patient-specific abdominal aneurysm model including the aorto-iliac bifurcation was measured by 2D PIV. Phase-averaged velocities obtained in 14 planes reveal details of the flow evolution during a cycle. The aneurysm expanding asymmetrically toward the anterior side of the aorta causes the generation of a vortex at its entrance, covering the entire aneurysm bulge progressively before flow peak. The fluid entering the aneurysm impinges on the left side of its distal end, following the axis of the upstream aorta segment, causing an increased flow rate in the left (compared to the right) common iliac artery. High shear stresses appear at the aneurysm inlet and outlet as well as along the posterior wall, varying proportionally to the flow rate. At the same regions, elevated flow disturbances are observed, being intensified at flow peak and during the deceleration phase. Low shear stresses are present in the recirculation region, being two orders of magnitude smaller than the previous ones. At flow peak and during the deceleration phase, a clockwise swirling motion (viewed from the inlet) is present in the aneurysm due to the out of plane curvature of the aorta.

  2. Case report: aneurysm of an aberrant right subclavian artery diagnosed with MR imaging.

    PubMed

    Turkenburg, J L; Versteegh, M I; Shaw, P C

    1994-11-01

    An aberrant right subclavian artery (ARSCA), also known as arteria lusoria, is the most common congenital anomaly of the aortic arch, with a reported prevalence ranging from 0.4 to 2%. The ARSCA arises as the last branch of the aortic arch and crosses the mediastinum from left to right indenting the oesophagus posteriorly. Aneurysms of this aberrant vessel, whether or not arising from a Kommerell's diverticulum, are rare. A 79-year-old woman is presented, in whom a partly thrombosed aneurysm of an ARSCA was diagnosed with magnetic resonance (MR) imaging.

  3. Large Renal Artery Aneurysm Treated with Guglielmi Detachable Coils: Procedural and 4-Year Follow-up Results

    SciTech Connect

    Damascelli, Bruno; Bartorelli, Antonio L.; Ticha, Vladimira; Trabattoni, Daniela; Lanocita, Rodolfo

    2008-07-15

    A large aneurysm of the left renal artery was found incidentally during abdominal ultrasound in a 39-year-old woman with no medical or family history of cardiovascular disease. Vascular pathology with a dysplastic appearance was confirmed by magnetic resonance angiography and the patient was offered transcatheter embolization. Since the position and size of the neck of the aneurysm could not be determined at angiography, detachable platinum coils were used for occlusion. The procedure was performed without complications. During a 4-year follow-up no alterations of renal function, recanalization of the aneurysm, or perfusion defects in the rest of the left renal circulation were noted.

  4. Posterior Tibial Tendon Dysfunction

    MedlinePlus

    ... when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be ... repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. ...

  5. Indirect posterior composite resins.

    PubMed

    Leinfelder, Karl F

    2005-07-01

    The use of indirect posterior composite restorations has facilitated the generation of ideal anatomic form, marginal adaptation, and appropriate proximal contact and contour. Unfortunately, however, the use of post-cure heat treatments has done little to enhance the overall clinical performance of the restoration. The development of new curing techniques in conjunction with modifications of the formulae have contributed to a substantial improvement in both the mechanical characteristics and long-term clinical performance of indirect posterior composite resins.

  6. Basilar vascular system supplied by only right proatlantal intersegmentary artery type 1 with aneurysm and left internal carotid occlusion: a case report and review from the literature.

    PubMed

    Ferrone, Alessandro; Brogna, Barbara; Giliberti, Raffaele; Vassallo, Pasquale; De Magistris, Giuseppe

    2016-09-01

    Persistence of proatlantal artery (PA) is a rare condition. More than 40 cases were described in the literature. Aneurysm may involve the PA itself in approximately 2% of cases, most arising from the internal carotid artery (ICA) side of PA. This case was particular because the PA showed a saccular aneurysm on the posterior wall, probably due to atherosclerosis disease and other alterations: plaque ulcerative of ICA, occlusion of left ICA, and aberrant right VA. PMID:27594943

  7. Primary Epiphyseal Aneurysmal Bone Cyst Of Distal Ulna

    PubMed Central

    Kapila, Rajesh; Sharma, Rakesh; Sohal, Yadwinder Singh; Singh, Dhalwinder; Singh, Sukhpal

    2015-01-01

    Introduction: Aneurysmal Bone Cyst (ABC) is a benign expansile cystic blood filled reactive lesion of the bone, most common in the first 2 decades of life. Though it can involve any bone in the body but tibia, humerus, femur and posterior elements of spine are most commonly affected. They most commonly involve metaphysis or metaphysio-diaphyseal part of the bone. Primary involvement of epiphysis is rarely reported. Here we present a case of 6 year old male child with an epiphyseal ABC of distal ulna. Its diagnosis, surgical management, clinical outcome with review of literature is discussed. PMID:27299110

  8. Unruptured Intracranial Aneurysms

    PubMed Central

    Raymond, J.; Guillemin, F.; Proust, F.; Molyneux, A.J.; Fox, A.J.; Claiborne, J.S.; Meder, J.-F.; Rouleau, I.

    2008-01-01

    Summary The preventive treatment of unruptured aneur­ysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blin­ding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5-1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem. PMID:20557790

  9. Arteriosclerotic coronary arterial aneurysms in a 49-year-old man with crescendo angina: family history, natural course and prevalence.

    PubMed

    Schneider, K W; Jesse, R; Deeg, P

    1977-01-01

    In a 49-year-old man with crescendo angina, elevated serum cholesterol level and an old posterior myocardial infarction, selective coronary arteriography showed multiple arteriosclerotic aneurysms of the right coronary artery associated with extensive and severe arteriosclerotic disease of the left coronary artery. The patient's mother and brother have both died of a myocardial infarction. Another brother suffers from angina and has documented arteriosclerotic coronary artery disease. Two sisters suffer from angina as well. The possibility of embolization of distal vessels from a friable clot of the aneurysms as a cause of the patient's infarction is discussed. To the best of our knowledge, this is the tenth patient with nonfistulous arteriosclerotic coronary artery aneurysm diagnosed and documented angiographically ante mortem. Including the present case and reviewing the literature, the prevalence of this condition among nonfistulous coronary aneurysms diagnosed ante mortem is 35 per cent and henceforth cannot be regarded as an incidental autopsy finding in cardiac asymptomatic patients.

  10. Spontaneous thrombosis in giant intracranial aneurysms.

    PubMed Central

    Whittle, I R; Dorsch, N W; Besser, M

    1982-01-01

    Twelve patients in a series of 22 with giant intracranial aneurysms demonstrated neuroradiological features of partial or total spontaneous intra-aneurysmal thrombosis. The presence of this intra-aneurysmal clot significantly altered the computed tomographic appearance of the giant aneurysm. Massive intra-aneurysmal thrombosis did not protect against subarachnoid haemorrhage and the likelihood of rupture of a clot containing giant aneurysm was not significantly different from that of a non-thrombosed giant aneurysm. Although parent artery occlusion from a thrombosed giant aneurysm, and massive aneurysmal thrombosis leading to the formation of giant serpentine aneurysm were documented, these are rare epiphenomena. The risk of embolisation from a partially thrombosed giant aneurysm, which was documented in one case, would appear to be greater than that from a non-thrombosed giant aneurysm. The findings in this series, and a review of literature, suggest that the presence of intra-aneurysmal clot in giant intracranial aneurysms has little prognostic significance and does not alter the management or outcome after treatment. Images PMID:7175528

  11. Techniques in Endovascular Aneurysm Repair

    PubMed Central

    Phade, Sachin V.; Garcia-Toca, Manuel; Kibbe, Melina R.

    2011-01-01

    Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies. PMID:22121487

  12. Magnetic resonance imaging of abdominal aortic aneurysms. [Aneurysm

    SciTech Connect

    Lee, J.K.T.; Ling, D.; Heiken, J.P.; Glazer, H.S.; Sicard, G.A.; Totty, W.G.; Levitt, R.G.; Murphy, W.A.

    1984-12-01

    Magnetic resonance imaging (MRI) was performed in 20 patients with radiologically or surgically proven abdominal aortic aneurysms using a Siemens Magnetom scanner with a 0.35-T superconductive magnet. Of nine patients who underwent surgical repair, MRI correctly demonstrated the origin of the aortic aneurysm in nine and accurately determined the status of the iliac arteries in eight. Of 11 patients who did not have surgical repair, MRI findings correlated well with other radiologic studies. MRI was found to be more reliable than sonography in determining the relation between the aneurysm and the renal arteries as well as the status of the iliac arteries. Despite these advantages, the authors still advocate sonography as the screening procedure of choice in patients with suspected abdominal aortic aneurysms because of its lower cost and ease of performance. MRI should be reserved for patients who have had unsuccessful or equivocal sonographic examinations.

  13. Idiopathic cystic artery aneurysm complicated with hemobilia.

    PubMed

    Anand, Utpal; Thakur, Sanjeev Kumar; Kumar, Sanjay; Jha, Achyutanand; Prakash, Vijay

    2011-01-01

    Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inflammatory process in the abdomen or abdominal trauma. We report a healthy individual who developed hemobilia associated with cystic artery aneurysm. The patient was managed with cholecystectomy and concomitant aneurysm repair. Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization is a common method of treatment for visceral artery aneurysms. Open cholecystectomy and aneurysm repair was performed in our patient due to radiological evidence of associated cholecystitis.

  14. Thoracic aorta aneurysm successfully operated on during pregnancy

    PubMed Central

    Biskupski, Andrzej; Kuligowska, Ewelina; Listewnik, Mariusz; Brykczyński, Mirosław

    2014-01-01

    We present the case of an asymptomatic 26-year-old female patient with a huge thoracic aneurysm discovered at a routine echo screening. The patient had previously been operated on for coarctation of the aorta in childhood and also had diagnosed bicuspid aortic valve. The operation was carried out in extracorporeal circulation at the 22nd week of gestation without any complications. A few months later in the 38th week of pregnancy a baby girl was delivered by cesarean section with an Apgar score of 10. The patient is scheduled for implantation of a stent graft to the descending aorta, because the CT of the chest done a few months after delivery confirmed presence of a significant aneurysm located just below the left subclavian artery. PMID:26336442

  15. Far-lateral approach for surgical treatment of fusiform PICA aneurysm.

    PubMed

    Couldwell, William T; Neil, Jayson A

    2015-01-01

    Ruptured fusiform posterior inferior cerebellar artery (PICA) aneurysms can be technically challenging lesions. Surgeons must be ready to employ a variety of strategies in the successful treatment of these aneurysms. Strategies include complex clip techniques including clip-wrapping or trapping and revascularization. The case presented here is of a man with subarachnoid hemorrhage from a fusiform ruptured PICA aneurysm. The technique demonstrated is a far-lateral approach and a clip-wrap technique using muslin gauze. The patient was given aspirin preoperatively in preparation for possible occipital-PICA bypass if direct repair was not feasible. It is the authors' preference to perform direct vessel repair as a primary goal and use bypass techniques when this is not possible. Vessel patency was evaluated after clip-wrapping using intraoperative Doppler. Intraoperative somatosensory and motor evoked potential monitoring is used in such cases. The patient recovered well. The video can be found here: http://youtu.be/iwLqufH47Ds .

  16. Endovascular coiling of a ruptured basilar apex aneurysm with associated pseudoaneurysm.

    PubMed

    Yanamadala, Vijay; Lin, Ning; Zarzour, Hekmat; Frerichs, Kai U; Walcott, Brian P; Thomas, Ajith J; Puri, Ajit S

    2014-09-01

    Acute intracranial pseudoaneurysms secondary to aneurysmal rupture are a rare entity with no clear evidence-based guidelines for treatment to our knowledge. There are numerous examples of successful treatment of pseudoaneurysms both surgically and endovascularly, the latter mainly within the anterior circulation. Risk of pseudoaneurysm rupture in the acute state during endovascular procedures with subsequent difficulty in controlling the bleeding without sacrificing the feeder artery has led to some reservation in using endovascular treatments more broadly. We report a rare case of a 52-year-old-woman who presented with acute subarachnoid hemorrhage and was found to have a ruptured 5 mm × 8 mm bi-lobulated basilar apex aneurysm on CT angiography. Digital subtraction angiography demonstrated an associated anterior pseudoaneurysm that was formed secondary to the aneurysm rupture. The true aneurysm was successfully coiled with careful avoidance of the pseudoaneurysmal sac. Pseudoaneurysms are frequently identified for the first time during digital subtraction angiography. Recognizing their presence is essential for treatment planning. Acute pseudoaneurysms associated with true aneurysmal rupture can be safely and successfully treated by endovascular coiling of the true aneurysm. Care must be taken to avoid manipulation of the pseudoaneurysmal sac during the embolization.

  17. The tibialis posterior tendon.

    PubMed

    Lhoste-Trouilloud, A

    2012-02-01

    The tibialis posterior tendon is the largest and anteriormost tendon in the medial ankle. It produces plantar flexion and supination of the ankle and stabilizes the plantar vault. Sonographic assessment of this tendon is done with high-frequency, linear-array transducers; an optimal examination requires transverse retromalleolar, longitudinal retromalleolar, and distal longitudinal scans, as well as dynamic studies. Disorders of the posterior tibial tendon include chronic tendinopathy with progressive rupture, tenosynovitis, acute rupture, dislocation and instability, enthesopathies. The most common lesion is a progressive "chewing gum" lesion that develops in a setting of chronic tendinopathy; it is usually seen in overweight women over 50 years of age with valgus flat feet. Medial ankle pain must also be carefully investigated, and the presence of instability assessed with dynamic maneuvers (forced inversion, or dorsiflexion) of the foot. Sonography plays an important role in the investigation of disorders involving the posterior tibial tendon.

  18. Distribution of Wall Stress in Abdominal Aortic Aneurysm (AAA)

    NASA Astrophysics Data System (ADS)

    Lasheras, Juan

    2005-11-01

    Abdominal aortic aneurysm (AAA) rupture is believed to occur when the mechanical stress acting on the wall exceeds the strength of the wall tissue. Therefore, knowledge of the AAA wall stress distribution could be useful in assessing its risk of rupture. In our research, a finite element analysis was used to determine the wall stresses both in idealized models and in a real clinical model in which the aorta was considered isotropic with nonlinear material properties and was loaded with a given pressure. In the idealized models, both maximum diameter and asymmetry were found to have substantial influence on the distribution of the wall stress. The thrombus inside the AAA was also found to help protecting the walls from high stresses. Using CT scans of the AAA, the actual geometry of the aneurysm was reconstructed and we found that wall tension increases on the flatter surface (typically corresponds to the posterior surface) and at the inflection points of the bulge. In addition to the static analysis, we also performed simulations of the effect of unsteady pressure wave propagation inside the aneurysm.

  19. Hemodynamic Intervention of Cerebral Aneurysms

    NASA Astrophysics Data System (ADS)

    Meng, Hui

    2005-11-01

    Cerebral aneurysm is a pathological vascular response to hemodynamic stimuli. Endovascular treatment of cerebral aneurysms essentially alters the blood flow to stop them from continued growth and eventual rupture. Compared to surgical clipping, endovascular methods are minimally invasive and hence rapidly gaining popularity. However, they are not always effective with risks of aneurysm regrowth and various complications. We aim at developing a Virtual Intervention (VI) platform that allows: patient-specific flow calculation and risk prediction as well as recommendation of tailored intervention based on quantitative analysis. This is a lofty goal requiring advancement in three areas of research: (1). Advancement of image-based CFD; (2) Understanding the biological/pathological responses of tissue to hemodynamic factors in the context of cerebral aneurysms; and (3) Capability of designing and testing patient-specific endovascular devices. We have established CFD methodologies based on anatomical geometry obtained from 3D angiographic or CT images. To study the effect of hemodynamics on aneurysm development, we have created a canine model of a vascular bifurcation anastomosis to provide the hemodynamic environment similar to those in CA. Vascular remodeling was studied using histology and compared against the flow fields obtained from CFD. It was found that an intimal pad, similar to those frequently seen clinically, developed at the flow impingement site, bordering with an area of `groove' characteristic of an early stage of aneurysm, where the micro environment exhibits an elevated wall shear stresses. To further address the molecular mechanisms of the flow-mediated aneurysm pathology, we are also developing in vitro cell culture systems to complement the in vivo study. Our current effort in endovascular device development focuses on novel stents that alters the aneurysmal flow to promote thrombotic occlusion as well as favorable remodeling. Realization of an

  20. Aneurysm of the Splenic Artery

    PubMed Central

    Bedford, P. D.; Lodge, Brian

    1960-01-01

    This paper records an incidence of 10·4% of aneurysm of the splenic artery in 250 consecutive routine post-mortem examinations. Medial degeneration seemed to be the commonest cause of such aneurysms and although a number were associated with other intraabdominal pathology, including portal hypertension, the association may be fortuitous and not causal. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6 PMID:13688586

  1. Flow Diverters for Intracranial Aneurysms

    PubMed Central

    Alderazi, Yazan J.; Kass-Hout, Tareq; Prestigiacomo, Charles J.; Gandhi, Chirag D.

    2014-01-01

    Flow diverters (pipeline embolization device, Silk flow diverter, and Surpass flow diverter) have been developed to treat intracranial aneurysms. These endovascular devices are placed within the parent artery rather than the aneurysm sac. They take advantage of altering hemodynamics at the aneurysm/parent vessel interface, resulting in gradual thrombosis of the aneurysm occurring over time. Subsequent inflammatory response, healing, and endothelial growth shrink the aneurysm and reconstruct the parent artery lumen while preserving perforators and side branches in most cases. Flow diverters have already allowed treatment of previously untreatable wide neck and giant aneurysms. There are risks with flow diverters including in-stent thrombosis, perianeurysmal edema, distant and delayed hemorrhages, and perforator occlusions. Comparative efficacy and safety against other therapies are being studied in ongoing trials. Antiplatelet therapy is mandatory with flow diverters, which has highlighted the need for better evidence for monitoring and tailoring antiplatelet therapy. In this paper we review the devices, their uses, associated complications, evidence base, and ongoing studies. PMID:24967131

  2. Left Main Coronary Artery Aneurysm

    PubMed Central

    Doustkami, Hossein; Maleki, Nasrollah; Tavosi, Zahra

    2016-01-01

    Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic. PMID:27403190

  3. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures.

  4. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures. PMID:26991573

  5. When Blood Vessels Bulge: All About Aneurysms

    MedlinePlus

    ... Vessels Bulge When Blood Vessels Bulge All About Aneurysms An aneurysm—a balloon-like bulge in an artery—can ... for years without causing any symptoms. But an aneurysm is a silent threat to your health. If ...

  6. Aneurysms - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Aneurysms URL of this page: https://medlineplus.gov/languages/aneurysms.html Other topics A-Z A B ...

  7. Medical management of small abdominal aortic aneurysms.

    PubMed

    Baxter, B Timothy; Terrin, Michael C; Dalman, Ronald L

    2008-04-01

    Abdominal aortic aneurysm is a common condition that may be lethal when it is unrecognized. Current guidelines suggest repair as the aneurysm diameter reaches 5.0 to 5.5 cm. Most aortic aneurysms are detected incidentally when imaging is done for other purposes or through screening programs. Ninety percent of these aneurysms are below the threshold for intervention at the time of detection. A number of studies have sought to determine factors that lead to progression of aneurysmal disease that might be amenable to intervention during this period of observation. We review these studies and make recommendations for the medical management of small abdominal aortic aneurysms. On the basis of our current knowledge of the causes of aneurysm, a number of approaches have been proposed to prevent progression of aneurysmal disease. These include hemodynamic management, inhibition of inflammation, and protease inhibition. The American College of Cardiology/American Heart Association clinical practice guidelines rules of evidence have helped to define strength of evidence to support these approaches. Level A evidence (from large randomized trials) is available to indicate that observation of small aneurysms in men is safe up to a size of 5.5 cm and that propranolol does not inhibit aneurysm expansion. Level B evidence (from small randomized trials) suggests that roxithromycin or doxycycline will decrease the rate of aneurysm expansion. A number of studies agree that tobacco use is associated with an increased rate of aneurysm expansion. Level B and C evidence is available to suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may inhibit aneurysm expansion. There are animal data but no human data demonstrating that angiotensin-converting enzyme inhibitors or losartan, an angiotensin receptor blocker, will decrease the rate of AAA expansion. A pharmacological agent without important side effects that inhibited aneurysm expansion could change

  8. Endovascular Exclusion of Renal Artery Aneurysm

    SciTech Connect

    Andersen, Poul Erik Rohr, Nils

    2005-06-15

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90{sup o}, but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable.

  9. [Albert Einstein and his abdominal aortic aneurysm].

    PubMed

    Cervantes Castro, Jorge

    2011-01-01

    The interesting case of Albert Einstein's abdominal aortic aneurysm is presented. He was operated on at age 69 and, finding that the large aneurysm could not be removed, the surgeon elected to wrap it with cellophane to prevent its growth. However, seven years later the aneurysm ruptured and caused the death of the famous scientist.

  10. Transcatheter Coil Embolization of Splenic Artery Aneurysm

    SciTech Connect

    Yamamoto, Satoshi Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

    2008-05-15

    The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.

  11. Hepatic artery mycotic aneurysm of tubercular aetiology.

    PubMed

    Beeresha; Ghotekar, L H; Dutta, T K; Verma, S K; Elangovan, S

    2000-02-01

    Hepatic artery aneurysm caused by tuberculosis is extremely rare, the commonest being atherosclerosis and vasculitis. A 13 year boy admitted with suspected disseminated tuberculosis had a hepatic bruit. Patient died of aneurysmal rupture before antemortem etiological diagnosis could be established. Postmortem examination revealed widespread tubercular lesions in the chest and abdomen and hepatic artery aneurysm.

  12. Lung Circulation.

    PubMed

    Suresh, Karthik; Shimoda, Larissa A

    2016-04-01

    The circulation of the lung is unique both in volume and function. For example, it is the only organ with two circulations: the pulmonary circulation, the main function of which is gas exchange, and the bronchial circulation, a systemic vascular supply that provides oxygenated blood to the walls of the conducting airways, pulmonary arteries and veins. The pulmonary circulation accommodates the entire cardiac output, maintaining high blood flow at low intravascular arterial pressure. As compared with the systemic circulation, pulmonary arteries have thinner walls with much less vascular smooth muscle and a relative lack of basal tone. Factors controlling pulmonary blood flow include vascular structure, gravity, mechanical effects of breathing, and the influence of neural and humoral factors. Pulmonary vascular tone is also altered by hypoxia, which causes pulmonary vasoconstriction. If the hypoxic stimulus persists for a prolonged period, contraction is accompanied by remodeling of the vasculature, resulting in pulmonary hypertension. In addition, genetic and environmental factors can also confer susceptibility to development of pulmonary hypertension. Under normal conditions, the endothelium forms a tight barrier, actively regulating interstitial fluid homeostasis. Infection and inflammation compromise normal barrier homeostasis, resulting in increased permeability and edema formation. This article focuses on reviewing the basics of the lung circulation (pulmonary and bronchial), normal development and transition at birth and vasoregulation. Mechanisms contributing to pathological conditions in the pulmonary circulation, in particular when barrier function is disrupted and during development of pulmonary hypertension, will also be discussed. PMID:27065170

  13. Posterior microphthalmos pigmentary retinopathy syndrome.

    PubMed

    Pehere, Niranjan; Jalali, Subhadra; Deshmukh, Himanshu; Kannabiran, Chitra

    2011-04-01

    Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted.

  14. Rebleeding after aneurysmal subarachnoid hemorrhage.

    PubMed

    Starke, R M; Connolly, E S

    2011-09-01

    Rebleeding after initial aneurysmal subarachnoid hemorrhage (SAH) can have substantial impact on overall patient outcome. While older studies have suggested rebleeding occurs in about 4% of patients during the first day after initial aneurysmal bleed, these studies may have failed to capture very early rebleeds and, consequently, underestimated the impact of rebleeding. An electronic literature search was performed to identify English-language articles published or available for review from February 1975 through October 2010. A total of 43 articles (40 original research and 3 review articles) focused on rebleeding after initial aneurysmal SAH in humans were selected for review. Although most studies supported an incidence of rebleeding ≤4%, studies investigating ultra-early rebleeding reported bleeding within the first 24 h following aneurysmal SAH in as many as 9-17% of patients, with most cases occurring within 6 h of initial hemorrhage. Overall, studies investigating antifibrinolytic therapy to reduce rebleeding have failed to clearly demonstrate overall therapeutic benefit. Short-course antifibrinolytic therapy may have a role prior to initial aneurysm repair, although insufficient data are currently available. PMID:21761274

  15. Anomalous Right Subclavian Artery Aneurysms

    PubMed Central

    Knight, Gordon C.; Codd, John E.

    1991-01-01

    During the past 2 years, 3 anomalous right subclavian artery aneurysms have been encountered at the St. Louis Heart Institute. The 1st patient, a 72-year-old woman, was found to have an asymptomatic 5-cm-diameter anomalous right subclavian artery aneurysm after surgery for suspected rupture of an abdominal aortic aneurysm. Resection was not attempted because of her poor cardiopulmonary and renal condition. One year later, the patient remains alive with marked cardiopulmonary limitations. The 2nd patient, a 77-year-old man, experienced dysphagia and severe weight loss because of a 14-cm-diameter aneurysm. Three days after undergoing surgical repair, he required reoperation for graft occlusion with right upper-extremity ischemia. Six months after hospital discharge, he died of pulmonary insufficiency and metastatic colon cancer. The 3rd patient, a 73-year-old woman, required emergency surgical intervention because of acute rupture and hypovolemic shock. Thirteen days later, she died of aspiration, asphyxia, and cardiac arrest. On the basis of our experience and a review of the literature, we conclude that symptomatic anomalous right subclavian artery aneurysms are rare, and that surgical intervention entails a relatively high morbidity and mortality rate. If long-term survival is anticipated, associated medical illnesses should be considered before surgery is undertaken. (Texas Heart Institute Journal 1991;18:209-18) Images PMID:15227483

  16. Endovascular Repair of Thoracic Aortic Aneurysms

    PubMed Central

    Findeiss, Laura K.; Cody, Michael E.

    2011-01-01

    Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here. PMID:22379281

  17. Idiopathic thoracic aortic aneurysm at pediatric age.

    PubMed

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  18. Surgery of intracranial aneurysms at Yonsei University: 780 cases.

    PubMed

    Lee, K C

    1991-03-01

    Seven hundred and eighty patients with intracranial aneurysm, which were surgically treated by the author since 1976, were analyzed. Strategies important for intracranial aneurysm surgery were the timing of surgery, preoperative preparation and intraoperative management. The best management outcome could be achieved by early operation, removal of subarachnoid blood clot, maintenance of circulating blood volume, administration of nimodipine, and meticulous surgical tactics to avoid pitfalls. Indications for aneurysm surgery in the acute phase were determined by intracerebral hematoma, angiographic findings, clinical grade, general physical status and readiness of the surgical team. Important goals to be considered during the operation were obtaining a slack brain, preparation of proximal control, protection of the brain, awareness of microsurgical anatomy, and complete dissection of the sac. The morbidity and mortality were 2.7% and 4.0%, respectively. The mortality was attributed to intracranial causes in 20 cases (poor grade, delayed ischemic deficits, rebleeding, postoperative infarction, and postoperative epidural hematoma), extracranial causes in 7 cases (pulmonary embolism, heparin induced intracerebral hemorrhage, hepatic failure, myocardial infarction, and gastrointestinal bleeding), and unknown problems in 5 cases. The postoperative intracerebral hemorrhage occurred in 16 cases and seemed to be caused by one or more of the following events: cerebral infarction developed during the preoperative period, occlusion of the cerebral veins during the Sylvian dissection, cerebral retraction and/or sudden change of intracranial hemodynamics. Hydrocephalus, almost always a communicating type as confirmed by isotope cisternography, was managed by lumboperitoneal shunt.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2046205

  19. Endovascular treatment for ruptured distal anterior inferior cerebellar artery aneurysm -case report-.

    PubMed

    Ishii, Daizo; Takechi, Akihiko; Shinagawa, Katsuhiro; Sogabe, Takashi

    2010-01-01

    A 73-year-old woman presented with subarachnoid hemorrhage caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin subarachnoid hemorrhage in the ambient cistern, and digital subtraction angiography revealed an aneurysm arising from the lateral branch of the left AICA, which was separate from the meatal loop. Endovascular treatment was performed to achieve parent artery occlusion using two Guglielmi detachable coils. Postoperatively, the patient had no complications except for left hearing disturbance, and she was independent in daily life. Endovascular parent artery occlusion for distal AICA aneurysm, especially distal from the meatal loop, can avoid sacrificing the internal auditory artery if the lateral branch of the AICA could be occluded more distally from the meatal loop. Sufficient collateral circulation prevents major infarction, and this strategy may be the first-line treatment choice. PMID:20505296

  20. Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: A systematic review

    PubMed Central

    McLaughlin, Nancy; McArthur, David L.; Martin, Neil A.

    2013-01-01

    Background: The use of stent-assisted coiling (SAC) has been shown to be a treatment option for complex aneurysms. We reviewed systematically the immediate and mid-term angiographic results following treatment of wide-necked aneurysms with self-expanding stents and coils, as well as the peri- and postprocedural rate of complications. Methods: A computerized database search was conducted from 01/2000 to 04/2011 using appropriate indexed terms on Pubmed. Inclusion criteria were: (1) homogeneous populations of ≥10 patients with wide-necked aneurysms; (2) use of a self-expandable neurovascular stent and coils for aneurysm treatment; (3) immediate and follow-up angiographic results; and (4) periprocedural and delayed thrombotic complications. Results: Seventeen studies were included, containing retrospectively collected data on 656 patients/702 aneurysms. The target aneurysm was located on the anterior circulation in 78.4% of patients. The immediate rate of complete occlusion was 46.3%, (19.3-98.1%). The intra- and postprocedural rate of intrastent thrombosis or thromboembolic event was 4.6% and 4.3%, respectively. Complete occlusion was documented in 71.9% at last angiographic follow-up. The rate of recanalization was 13.2% of aneurysms (0-28.8%). Delayed in-stent stenosis occurred in 5.3% cases (0-20.6%). Conclusion: SAC has been considered a treatment option for selected wide-necked aneurysms in some institutions. The use of intracranial stents should take into consideration the risk of ischemic complications, recanalization, delayed in-stent stenosis; and the currently unknown lifetime risks for stenosis, vascular injury, device failure, and aneurysm recurrence related to intracranial stenting. There is an evident need for a prospective multicenter registry for all treated patients with SAC. PMID:23607065

  1. Thoracic aortic aneurysms and pregnancy.

    PubMed

    Coulon, Capucine

    2015-11-01

    Half of acute aortic dissection in women under the age of 40 occurs during pregnancy or peripartum period. Marfan syndrome is the most common syndromic presentation of ascending aortic aneurysm, but other syndromes such as vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Turner syndrome also have ascending aortic aneurysms and the associated cardiovascular risk of aortic dissection and rupture. Management of aortic root aneurysm has been established in recent recommendations, even if levels of evidence are weak. Pregnancy and postpartum period should be followed very closely and determined to be at high risk. Guidelines suggest that women with aortopathy should be counseled against the risk of pregnancy and about the heritable nature of the disease prior to pregnancy.

  2. Thoracic aortic aneurysms and pregnancy.

    PubMed

    Coulon, Capucine

    2015-11-01

    Half of acute aortic dissection in women under the age of 40 occurs during pregnancy or peripartum period. Marfan syndrome is the most common syndromic presentation of ascending aortic aneurysm, but other syndromes such as vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Turner syndrome also have ascending aortic aneurysms and the associated cardiovascular risk of aortic dissection and rupture. Management of aortic root aneurysm has been established in recent recommendations, even if levels of evidence are weak. Pregnancy and postpartum period should be followed very closely and determined to be at high risk. Guidelines suggest that women with aortopathy should be counseled against the risk of pregnancy and about the heritable nature of the disease prior to pregnancy. PMID:26454306

  3. [Clinical study on the surgical cases of the ruptured thoracic aortic aneurysm].

    PubMed

    Ayabe, T; Nakamura, K; Yano, M; Onitsuka, T

    2003-07-01

    The prognosis of the ruptured thoracic aortic aneurysm is poor. Even if the surgical treatment was performed, the clinical outcome does not sufficiently satisfy us. Between January 1978 to July 1999, 171 cases of thoracic aortic surgery were operated in our department, in which 12 patients were with the ruptured thoracic aortic aneurysm without acute dissection. The aneurysm was located in ascending aorta (2), aortic arch (6), descending aorta (3), and thoracoabdominal aorta (1). The aneurysm was ruptured into thorax (4), pericardium (2), mediastinum (3), lung (2), and esophagus (1). The operative procedure was artificial vascular graft replacement (9), patch closure (2), and aneurysmal interposition (1) [bypass with ascending aorta to abdominal aorta)]. The operations were performed during hypothermic circulatory arrest with antegrade selective cerebral perfusion (6), under total (1) or partial complete extracorporeal circulation (5). The hospital death was 33% (4/12). The causes of death were cerebral complication (2), sepsis (1), and multiple organ failure (1). The 12 patients were divided into 2 groups: group A; 8 cases with alive; group D; 4 cases with hospital death. We compared and analyzed the perioperative factors of these 2 groups. On intraoperative factors, operation time (minute) demonstrated a significant difference (498 +/- 129 in group A v.s. 851 +/- 227 in group D, p < 0.05). No significant difference was observed between the groups on extracorporeal circulation time, aortic clumping time, selective cerebral perfusion time, systemic circulatory arrest time, intraoperative blood loss, and blood transfusion. The postoperative major complication was revealed in 6 cases (50%, 6/12), cerebral infarction (3), sepsis (2), and hoarsness (1). In conclusions, to make an effort to shorten an operative time as possible, and to prevent the postoperative neurological dysfunction under selective cerebral perfusion, those efforts should contribute to a good

  4. Abdominal aortic aneurysms: case report

    PubMed Central

    Hadida, Camille; Rajwani, Moez

    1998-01-01

    A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3

  5. Endovascular abdominal aortic aneurysm repair

    PubMed Central

    Norwood, M G A; Lloyd, G M; Bown, M J; Fishwick, G; London, N J; Sayers, R D

    2007-01-01

    The operative mortality following conventional abdominal aortic aneurysm (AAA) repair has not fallen significantly over the past two decades. Since its inception in 1991, endovascular aneurysm repair (EVAR) has provided an alternative to open AAA repair and perhaps an opportunity to improve operative mortality. Two recent large randomised trials have demonstrated the short and medium term benefit of EVAR over open AAA repair, although data on the long term efficacy of the technique are still lacking. This review aimed at providing an overview of EVAR and a discussion of the potential benefits and current limitations of the technique. PMID:17267674

  6. Leaking mycotic abdominal aortic aneurysm.

    PubMed

    Sing, T M; Young, N; O'Rourke, I C; Tomlinson, P

    1994-11-01

    A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhoea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogenes. PMID:7993259

  7. Position dependent right ventricular dysfunction caused by a giant right coronary artery aneurysm.

    PubMed

    Mora, Bruno; Urbanek, Bernhard; Loewe, Christian; Grimm, Michael; Dworschak, Martin

    2011-01-01

    We describe an instructive case of a 79-year-old patient with a giant coronary aneurysm and a second smaller aneurysm with an uncommon symptomatology. Giant coronary artery aneurysms (>2 cm diameter) are rare pathologic entities with a prevalence of 0.02%. They either can be congenital malformations or are atherosclerotic in origin. Although spontaneous rupture of giant coronary artery aneurysms has been reported, they generally remain silent or induce myocardial ischemia. Our patient, however, showed no signs of myocardial malperfusion but transient position-dependent pre-syncope. The cardiologic work-up and the intraoperative considerations regarding patient management are described. During surgery, manipulation of the giant coronary artery aneurysm caused impairment of right ventricular function and regional wall hypokinesia, as assessed by transesophageal echocardiography. Venous cannulation of the right atrium was thus abandoned and extracorporeal circulation was established via the femoral vein. Subsequent dissection and surgical repair were uneventful and further recovery of the elderly patient was uncomplicated. This case underlines that once the diagnosis is established, proper perioperative management enables successful surgical treatment even of patients of advanced age. PMID:21253776

  8. Patterns of attachment of the myodural bridge by the rectus capitis posterior minor muscle.

    PubMed

    Yuan, Xiao-Ying; Yu, Sheng-Bo; Li, Yun-Fei; Chi, Yan-Yan; Zheng, Nan; Gao, Hai-Bin; Luan, Bing-Yi; Zhang, Zhao-Xi; Sui, Hong-Jin

    2016-03-01

    The myodural bridge was first described by Hack in 1995 and was thought to be related to chronic cervicogenic headaches. For a long time, few studies revealed the patterns of the myodural bridge considering the rectus capitis posterior minor muscle. In this study, P45 plastination technology and anatomical dissection were performed on head specimens, and four different terminal region types of the rectus capitis posterior minor muscle were observed, including the posterior atlanto-occipital interspace, posterior arch of the atlas and posterior atlanto-axial interspace. We propose that the myodural complex structures in the posterior atlanto-occipital and posterior atlanto-axial interspace have cooperative effects on cerebrospinal fluid and work together. This force might be an important source for the circulation of cerebrospinal fluid. PMID:25859757

  9. Patterns of attachment of the myodural bridge by the rectus capitis posterior minor muscle.

    PubMed

    Yuan, Xiao-Ying; Yu, Sheng-Bo; Li, Yun-Fei; Chi, Yan-Yan; Zheng, Nan; Gao, Hai-Bin; Luan, Bing-Yi; Zhang, Zhao-Xi; Sui, Hong-Jin

    2016-03-01

    The myodural bridge was first described by Hack in 1995 and was thought to be related to chronic cervicogenic headaches. For a long time, few studies revealed the patterns of the myodural bridge considering the rectus capitis posterior minor muscle. In this study, P45 plastination technology and anatomical dissection were performed on head specimens, and four different terminal region types of the rectus capitis posterior minor muscle were observed, including the posterior atlanto-occipital interspace, posterior arch of the atlas and posterior atlanto-axial interspace. We propose that the myodural complex structures in the posterior atlanto-occipital and posterior atlanto-axial interspace have cooperative effects on cerebrospinal fluid and work together. This force might be an important source for the circulation of cerebrospinal fluid.

  10. Posterior Urethral Strictures.

    PubMed

    Gelman, Joel; Wisenbaugh, Eric S

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  11. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  12. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  13. Computational hemodynamics in cerebral aneurysms: the effects of modeled versus measured boundary conditions.

    PubMed

    Marzo, Alberto; Singh, Pankaj; Larrabide, Ignacio; Radaelli, Alessandro; Coley, Stuart; Gwilliam, Matt; Wilkinson, Iain D; Lawford, Patricia; Reymond, Philippe; Patel, Umang; Frangi, Alejandro; Hose, D Rod

    2011-02-01

    Modeling of flow in intracranial aneurysms (IAs) requires flow information at the model boundaries. In absence of patient-specific measurements, typical or modeled boundary conditions (BCs) are often used. This study investigates the effects of modeled versus patient-specific BCs on modeled hemodynamics within IAs. Computational fluid dynamics (CFD) models of five IAs were reconstructed from three-dimensional rotational angiography (3DRA). BCs were applied using in turn patient-specific phase-contrast-MR (pc-MR) measurements, a 1D-circulation model, and a physiologically coherent method based on local WSS at inlets. The Navier-Stokes equations were solved using the Ansys®-CFX™ software. Wall shear stress (WSS), oscillatory shear index (OSI), and other hemodynamic indices were computed. Differences in the values obtained with the three methods were analyzed using boxplot diagrams. Qualitative similarities were observed in the flow fields obtained with the three approaches. The quantitative comparison showed smaller discrepancies between pc-MR and 1D-model data, than those observed between pc-MR and WSS-scaled data. Discrepancies were reduced when indices were normalized to mean hemodynamic aneurysmal data. The strong similarities observed for the three BCs models suggest that vessel and aneurysm geometry have the strongest influence on aneurysmal hemodynamics. In absence of patient-specific BCs, a distributed circulation model may represent the best option when CFD is used for large cohort studies.

  14. Peripheral circulation.

    PubMed

    Laughlin, M Harold; Davis, Michael J; Secher, Niels H; van Lieshout, Johannes J; Arce-Esquivel, Arturo A; Simmons, Grant H; Bender, Shawn B; Padilla, Jaume; Bache, Robert J; Merkus, Daphne; Duncker, Dirk J

    2012-01-01

    Blood flow (BF) increases with increasing exercise intensity in skeletal, respiratory, and cardiac muscle. In humans during maximal exercise intensities, 85% to 90% of total cardiac output is distributed to skeletal and cardiac muscle. During exercise BF increases modestly and heterogeneously to brain and decreases in gastrointestinal, reproductive, and renal tissues and shows little to no change in skin. If the duration of exercise is sufficient to increase body/core temperature, skin BF is also increased in humans. Because blood pressure changes little during exercise, changes in distribution of BF with incremental exercise result from changes in vascular conductance. These changes in distribution of BF throughout the body contribute to decreases in mixed venous oxygen content, serve to supply adequate oxygen to the active skeletal muscles, and support metabolism of other tissues while maintaining homeostasis. This review discusses the response of the peripheral circulation of humans to acute and chronic dynamic exercise and mechanisms responsible for these responses. This is accomplished in the context of leading the reader on a tour through the peripheral circulation during dynamic exercise. During this tour, we consider what is known about how each vascular bed controls BF during exercise and how these control mechanisms are modified by chronic physical activity/exercise training. The tour ends by comparing responses of the systemic circulation to those of the pulmonary circulation relative to the effects of exercise on the regional distribution of BF and mechanisms responsible for control of resistance/conductance in the systemic and pulmonary circulations.

  15. Posterior Cortical Atrophy

    PubMed Central

    Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C

    2013-01-01

    Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management. PMID:22265212

  16. Giant Serpentine Aneurysms: Multidisciplinary Management

    PubMed Central

    Anshun, W.; Feng, L.; Daming, W.

    2000-01-01

    Summary Sixty-five cases of intracranial giant serpentine aneurysms (GSΛs), including 61 cases reported in the literature and four additional cases presented in this study were reviewed. The clinical presentation, possible causes, natural history, and especially management of GSAs are discussed with emphasis on the need for aggressive intervention and multidisciplinary management. PMID:20667180

  17. Dorsal variant blister aneurysm repair.

    PubMed

    Couldwell, William T; Chamoun, Roukoz

    2012-01-01

    Dorsal variant proximal carotid blister aneurysms are treacherous lesions to manage. It is important to recognize this variant on preoperative angiographic imaging, in anticipation of surgical strategies for their treatment. Strategies include trapping the involved segment and revascularization if necessary. Other options include repair of the aneurysm rupture site directly. Given that these are not true berry aneurysms, repair of the rupture site involves wrapping or clip-grafting techniques. The case presented here was a young woman with a subarachnoid hemorrhage from a ruptured dorsal variant blister aneurysm. The technique used is demonstrated in the video and is a modified clip-wrap technique using woven polyester graft material. The patient was given aspirin preoperatively as preparation for the clip-wrap technique. It is the authors' current protocol to attempt a direct repair with clip-wrapping and leaving artery sacrifice with or without bypass as a salvage therapy if direct repair is not possible. Assessment of vessel patency after repair is performed by intraoperative Doppler and indocyanine green angiography. Intraoperative somatosensory and motor evoked potential monitoring is performed in all cases. The video can be found here: http://youtu.be/crUreWGQdGo.

  18. Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

    PubMed Central

    Xu, Kan; Yu, Tiecheng; Guo, Yunbao; Yu, Jinlu

    2016-01-01

    An intracranial serpentine aneurysm (SA) is a clinically rare entity, and very few multi-case studies on SA have been published. The present study reviewed the relevant literature available on PubMed. The studied information included the formation mechanism and natural history of SA as well as its clinical manifestation, imaging characteristics, and current treatments. After reviewing the literature, we conclude that intracranial SA can be managed surgically and by endovascular embolization, but the degree of blood flow in normal brain tissue distal to the SA must be evaluated. A balloon occlusion test (BOT) or cross compression test is recommended for this evaluation. If the collateral circulation is sufficiently compensatory, direct excision or embolization can be performed. However, if the compensatory collateral circulation is poor, a bypass surgery is necessary. Satisfactory results can be achieved in the majority of SA patients after treatment. However, the size of the aneurysm may increase in some patients after endovascular treatment. Special attention should be paid to cases exhibiting a significant mass effect to avoid subsequent SA excision due to an intolerable mass effect. Satisfactory results can be achieved with careful treatment of SA. PMID:27279792

  19. Mechanics of left ventricular aneurysm.

    PubMed

    Radhakrishnan, S; Ghista, D N; Jayaraman, G

    1986-01-01

    When a coronary artery is significantly occluded, the left ventricular myocardial segment, which is perfused by that coronary artery, will become ischaemic and even irreversibly infarcted. An acute infarct has very low stiffness and if it involves the entire wall there is a risk of rupture; however, in the absence of such a critical situation, fibrous tissue is laid into the infarcted myocardial segment. Such an infarcted fibrotic myocardial segment will not be able to contract, and so generate tensile stress. The surrounding intact myocardium will contract and generate wall stress, thereby developing a high intra-chamber systolic pressure; the chronically infarcted and fibrotic segment will have to sustain this high chamber pressure. Its loss of contractility and the resulting reduced systolic stiffness relative to the intact segment, will cause it to deform into a bulge; this is an aneurysm. When a left ventricular chamber with an aneurysm contracts during the systolic phase, some blood also goes into the aneurysm, and this decreases the stroke volume; since the aneurysm wall is passive, stagnant blood flow prevails in the aneurysm itself, which in turn can give rise to the formation of a mural thrombus. These serious consequences provide a justification for the analysis of an infarcted left ventricular chamber, in order to predict the size of the aneurysmic bulge. Such an analysis is presented in this paper. To determine the left ventricular wall deformation, and the stress arising from infarction of a wall segment (which leads to a ventricular aneurysm) the left ventricle is modelled here as a pressurized ellipsoidal shell. Deformations of infarcted wall segments are computed for several damaged wall-thicknesses in left ventricles of different shapes. The analysis involves a derivation of equations for wall-stress equilibrium with the chamber pressure, and myocardial incompressibility before and after infarct formation. The equations are solved by the Newton

  20. Percutaneous Management of a Coronary Bifurcation Aneurysm with Mesh-Covered Stents and the Simultaneous Kissing Stent Technique.

    PubMed

    Crimi, Gabriele; Bartolini, Davide; Bellotti, Sandro; Iannone, Alessandro; Rubartelli, Paolo

    2015-08-01

    A 63-year-old man was admitted with a clinical diagnosis of acute coronary syndrome (non-ST-segment elevation), characterized by regional hypokinesia of the left ventricular posterior and lateral walls and by positive cardiac biomarkers. The coronary angiogram showed a 12.5-mm-diameter aneurysm with a mural thrombus and possible distal embolism to the bifurcation of the left circumflex coronary artery and the 2nd marginal branch. The aneurysm was managed percutaneously by implanting 2 mesh-covered stents in accordance with the "simultaneous kissing stent" technique. Follow-up angiography and optical coherence tomography at 5 postprocedural months documented complete sealing of the aneurysm and diffuse in-stent restenosis. No sign of ischemia occurred during the subsequent follow-up.

  1. Patient-specific computational analysis of the influence of a stent on the unsteady flow in cerebral aneurysms

    NASA Astrophysics Data System (ADS)

    Takizawa, Kenji; Schjodt, Kathleen; Puntel, Anthony; Kostov, Nikolay; Tezduyar, Tayfun E.

    2013-06-01

    We present a patient-specific computational analysis of the influence of a stent on the unsteady flow in cerebral aneurysms. The analysis is based on four different arterial models extracted form medical images, and the stent is placed across the neck of the aneurysm to reduce the flow circulation in the aneurysm. The core computational technique used in the analysis is the space-time (ST) version of the variational multiscale (VMS) method and is called "DSD/SST-VMST". The special techniques developed for this class of cardiovascular fluid mechanics computations are used in conjunction with the DSD/SST-VMST technique. The special techniques include NURBS representation of the surface over which the stent model and mesh are built, mesh generation with a reasonable resolution across the width of the stent wire and with refined layers of mesh near the arterial and stent surfaces, modeling the double-stent case, and quantitative assessment of the flow circulation in the aneurysm. We provide a brief overview of the special techniques, compute the unsteady flow patterns in the aneurysm for the four arterial models, and investigate in each case how those patterns are influenced by the presence of single and double stents.

  2. Pregnancy-related rupture of arterial aneurysms.

    PubMed

    Barrett, J M; Van Hooydonk, J E; Boehm, F H

    1982-09-01

    Over 50 per cent of ruptured arterial aneurysms in women under the age of 40 are pregnancy-related. The hemodynamic and endocrine changes of pregnancy appear to be the cause of arterial alterations which may lead to new aneurysm formation and/or weakening of preexisting aneurysms. The most commonly reported arteries to have aneurysms rupture during pregnancy are the aorta, cerebral arteries, splenic artery, renal artery, coronary artery, and ovarian artery. In many instances, the rupture of an arterial aneurysm will initially simulate other less serious disease processes, thus delaying the correct diagnosis until a catastrophic event occurs. Early diagnosis and treatment of a ruptured arterial aneurysm are imperative in order to give optimal chances of survival to the mother and fetus.

  3. Changes in geometric configuration and biomechanical parameters of a rapidly growing abdominal aortic aneurysm may provide insight in aneurysms natural history and rupture risk

    PubMed Central

    2013-01-01

    Background Abdominal aortic aneurysms (AAA) are currently being treated based on the maximum diameter criterion which has often been proven insufficient to determine rupture risk in case of every AAA. We analyzed a rare case of an AAA which presented an extremely fast growth focusing on biomechanical determinants that may indicate a high risk profile. The examination of such a case is expected to motivate future research towards patient-specific rupture risk estimations. Methods An initially small AAA (maximum diameter: 4.5 cm) was followed-up and presented a growth of 1 cm in only 6-months of surveillance becoming suitable for surgical repair. Changes of morphometric characteristics regarding AAA, thrombus and lumen volumes, cross-sectional areas, thrombus maximum thickness and eccentricity, and maximum centerline curvature were recorded. Moreover biomechanical variables concerning Peak Wall Stress, AAA surface area exposed to high stress and redistribution of stress during follow-up were also assessed. Results Total aneurysm volume increased from 85 to 120 ml which regarded thrombus deposition since lumen volume remained stable. Thrombus deposition was eccentric regarding anterior AAA segment while its thickness increased from 0.3 cm to 1.6 cm. Moreover there was an anterior bulging over time as depicted by an increase in maximum centerline curvature from 0.4 cm-1 to 0.5 cm-1. Peak Wall Stress (PWS) exerted on aneurysm wall did not change significantly over time, slightly decreasing from 22 N/cm2 to 21 N/cm2. At the same time the area under high wall stress remained practically constant (9.9 cm2 at initial vs 9.7 cm2 at final examination) but there was a marked redistribution of wall stress against the posterior aneurysmal wall over time. Conclusion Aneurysm area under high stress and redistribution of stress against the posterior wall due to changes in geometric configuration and thrombus deposition over time may have implications to aneurysms natural

  4. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  5. Assessment of endovascular coil configuration for embolization of intracranial aneurysms using computational fluid dynamics

    PubMed Central

    Ohshima, Tomotaka; Miyachi, Shigeru; Takahashi, Ichiro; Ishii, Katsuya

    2015-01-01

    ABSTRACT Endovascular coil embolization of arterial aneurysms is often complicated by reduced blood flow to branching arteries. To determine the optimal coil configuration for safe embolization of endovascular aneurysms without compromising blood flow in branching arteries. A 3-dimensional voxel model, built based on an unruptured vertebral artery–posterior inferior cerebellar artery (VA–PICA) aneurysm, predicted to show impairment of flow in the PICA during endovascular coil embolization (Case 0). Six different models of final coil configuration were generated and applied to this aneurysm. Case 1 was a round coil mass. Case 2 was designed with a stent assist. Cases 3, and 4 were designed with a neck remnant and Cases 5 and 6 incorporated a balloon neck remodeling technique. Computational fluid dynamics was used to analyze the flow in the PICA in each model. The average outflow to the PICA was highest in Case 0 and lowest in Case 2 (in descending order, Case 0, 5, 4, 6, 1, 3, and 2). There was better preservation of outflow to the PICA in the balloon neck remodeling models than in the neck remnant models. In a model of endovascular coil embolization, we found considerable differences in outflow to the branching artery with small changes in coil configuration. Careful preoperative planning is important to minimize the risk of thromboembolic events during and after endovascular coil embolization. PMID:26412884

  6. Clipping techniques in cerebral aneurysm surgery.

    PubMed

    Acciarri, Nicola; Toniato, Giovanni; Raabe, Andreas; Lanzino, Giuseppe

    2016-03-01

    The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms. PMID:26657306

  7. Infundibular dilatation of the posterior communicating artery in a defined population.

    PubMed

    Vlajković, Slobodan; Vasović, Ljiljana; Trandafilović, Milena; Jovanović, Ivan; Ugrenović, Slađana; Dorđević, Gordana

    2015-01-01

    Unusual widening of the posterior communicating artery (PCoA) at its beginning from the cerebral portion of the internal carotid artery (ICA) was described as its infundibular dilatation (ID). A possibility of ID rupture or progression to aneurysm was the reason for an investigation of its frequency and morphologic features in specimens of the Serbian population. Cerebral arteries on the brain base of 267 adult cadavers of both genders and varying age and causes of death were dissected. The images of the PCoA in 190 fetuses were also reviewed. ID of the PCoA was defined as a funnel shaped beginning of different width from ICA, wherein PCoA continues from ID apex to the posterior cerebral artery. There were no cases of ID in fetuses. ID and aneurysms of the PCoA were found in 6/267 or 2.2% and 3/267 or 1.12% of adults, respectively. Unilaterally, they existed on the left side and, frequently, in male cases aging 70 years and older, that had died without cerebral cause. Bilaterally, ID was found in 2/6 cases. There was only one case of ID and aneurysm of the PCoA, but from the ID. We are of the opinion that ID of the PCoA only develops postnatally and probably is due to the influence of hemodynamic factors or hypertension. PMID:25458180

  8. Acute subarachnoid hemorrhage in posterior condylar canal dural arteriovenous fistula: imaging features with endovascular management

    PubMed Central

    Mondel, Prabath Kumar; Saraf, Rashmi; Limaye, Uday S

    2014-01-01

    A 43-year-old man presented with acute subarachnoid hemorrhage. He was investigated and found to have a rare posterior condylar canal dural arteriovenous fistula (DAVF). DAVFs of the posterior condylar canal are rare. Venous drainage of the DAVF was through a long, tortuous, and aneurysmal bridging vein. We describe the clinical presentation, cross sectional imaging, angiographic features, and endovascular management of this patient. The patient was treated by transarterial embolization of the fistula through the ascending pharyngeal artery. This is the first report of an acutely bled posterior condylar canal DAVF treated by transarterial Onyx embolization with balloon protection in the vertebral artery. The patient recovered without any neurological deficit and had an excellent outcome. On 6 month follow-up angiogram, there was stable occlusion of the dural fistula. PMID:24990846

  9. Surgical repair of true left ventricular aneurysm in an infant: a rare complication after unsuccessful perventricular VSD closure.

    PubMed

    Ozyilmaz, Isa; Saygi, Murat; Yildiz, Okan; Erek, Ersin; Guzeltas, Alper

    2014-10-01

    A 2.5-month-old female patient presented for closure of a ventricular septal defect (VSD). Transthoracic echocardiography showed a large muscular ventricular septal defect. After perventricular closure of the defect was performed with an Amplatzer muscular VSD occluder, peroperative transesophageal echocardiography revealed that the device had been implanted in the wrong area of the ventricular septum. The device was retrieved and a large mid-muscular defect with extension to the outlet septum was closed with a patch of Dacron which was secured with 5-0 sutures. A perforation in the ventricular septum due to attempted perventricular device delivery was seen, and it was repaired primarily. In the eighth month of follow-up, transthoracic echocardiography revealed an aneurysm in the posterior wall of the left ventricle. The patient's electrocardiogram showed pathological Q waves and ST-segment elevation in leads DII, DIII, and aVF consistent with subacute inferior myocardial infarction. At subsequent surgery, this was found to be a true aneurysm, located in area of distribution of the obtuse marginal branch of the left circumflex coronary artery in the posterior wall of the left ventricle. The aneurysm was closed off using a Dacron patch, and the sac was resected. Development of a true aneurysm is a rare but important complication of attempted perventricular VSD closure.

  10. [Approach to juxtarenal inflammatory aneurysms].

    PubMed

    Scuro, A; Barzaghi, M E; Griso, A; Ferrari Ruffino, S; Kontothanassis, D; Mirandola, M; Leonardi, G; D'Agata, M

    2004-01-01

    The incidence of inflammatory abdominal aortic aneurysm (IAAA) in a late review of the literature is estimated about 2-15% overall aortic aneurysms. In our data this type of aneurysm is 3.6 overall aortic aneurysms treated. In the majority of the cases, IAAA is juxtarenal or infrarenal. Ethiopathogenesis of IAAA till today is not certain. Recent hypothesis on IAAA attribute the same ethiopathogenesis in both atherosclerotic and inflammatory aneurysm. The interaction of genetic, environmental and infective factors should be able to determine an autoimmune inflammatory reaction of variable severity. 80% of the patients suffering from IAAA present abdominal or lumbar pain, loss of weight and increase of the RC sedimentation velocity. The IAAA's natural history goes to rupture. Entrapment of nearstanding organs totally involved in the fibrotic process is the most frequent complication. Usually there is a compression of the ureter and the duodenum with consequenced hydroureteronephrosis and bowel obstruction. Preoperative diagnosis is possible; CT scan and MRI guarantee and accuracy about 90%. Intraoperatively the external wall of IAAA appears whitish and translucent and always there are tenacious adhesion given by the avventital wounds inflammation. Confirm is given by the histological examination of the aneurysmatic wall and peravventitial tissues. Our experience and a late review of the literature concorde that surgical indication for the treatment of IAAA is the same for the atherosclerotic one. This conviction is supported by the fact that the diagnostic methodical evolution and the improvement in mininvasive surgical technique lowered perioperating morbility and mortaliy. We prefer, according with many authors, retroperitoneal approach to juxtarenal IAAA, instead of standardized transperitoneal access with xifo-pubical or transversal under costal incision. This approach offers some advantages as easier exposition of aorta, whose postero-lateral wall is hardly ever

  11. Pulmonary artery aneurysm with patent arterial duct: resection of aneurysm and ductal division.

    PubMed

    Tefera, Endale; Teodori, Michael

    2013-10-01

    Congenital or acquired aneurysm of the pulmonary artery (PA) is rare. Although aneurysms are described following surgical treatment of patent ductus arteriosus (PDA), occurrence of this lesion in association with PDA without previous surgery is extremely uncommon. An eight-year-old patient with PDA and aneurysm of the main PA is described in this report. Clinical diagnosis of PDA was made upon presentation. Diagnosis of PA aneurysm was suspected on chest x-ray and was confirmed on transthoracic echocardiography. Successful surgical resection of the aneurysm and division of the duct were performed under cardiopulmonary bypass. The patient did well on follow-up both from clinical and echocardiographic point of view.

  12. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

    PubMed Central

    Orrapin, Saritphat; Arworn, Supapong; Reanpang, Termpong

    2016-01-01

    We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity. PMID:27703834

  13. Time evolution and hemodynamics of cerebral aneurysms

    NASA Astrophysics Data System (ADS)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  14. Correlation Between Aneurysm Size and Hemodynamics in One Individual with Multiple Small Intracranial Aneurysms.

    PubMed

    Jou, Liangder; Britz, Gavin

    2016-01-01

    Objective A large number of cases are needed in the patient-specific modeling of intracranial aneurysms to establish the statistical significance due to individual variation of risk factors that are difficult to account for. However, these risk factors are critical in hemorrhage risk as demonstrated in large clinical studies. Rupture risks for aneurysms in an individual are easier to compare because these aneurysms are under the same physiological environment, and their only differences are the local hemodynamic factors associated with their anatomic locations. Methods Eight small aneurysms (< 7 mm) from one individual were analyzed using patient-specific hemodynamic modeling. Four scenarios with different perfusion assumptions were performed to account for the flow rate at two smaller communicating arteries. Wall shear stresses (WSS) at these aneurysms were compared to determine their relationship with the aneurysm size. Results Each of the three largest aneurysms is either the most proximal or distal aneurysm in a given artery so that blood pressure does not have a direct influence on aneurysm size. No wall shear stress-derived hemodynamic variables are found to be related to aneurysm size. Discussion A study of multiple aneurysms from one individual offers a unique opportunity to examine various hemodynamic factors without selection biases. Aneurysms greater than 4 mm (Group 1) have a higher product of maximum WSS and area of low WSS; aneurysms smaller than 4 mm (Group 2) have a lower product of maximum WSS and area of low WSS. In addition, aneurysm size is linearly correlated with the flow rate at the parent artery in each group. PMID:27555981

  15. Correlation Between Aneurysm Size and Hemodynamics in One Individual with Multiple Small Intracranial Aneurysms

    PubMed Central

    Britz, Gavin

    2016-01-01

    Objective A large number of cases are needed in the patient-specific modeling of intracranial aneurysms to establish the statistical significance due to individual variation of risk factors that are difficult to account for. However, these risk factors are critical in hemorrhage risk as demonstrated in large clinical studies. Rupture risks for aneurysms in an individual are easier to compare because these aneurysms are under the same physiological environment, and their only differences are the local hemodynamic factors associated with their anatomic locations. Methods Eight small aneurysms (< 7 mm) from one individual were analyzed using patient-specific hemodynamic modeling. Four scenarios with different perfusion assumptions were performed to account for the flow rate at two smaller communicating arteries. Wall shear stresses (WSS) at these aneurysms were compared to determine their relationship with the aneurysm size. Results Each of the three largest aneurysms is either the most proximal or distal aneurysm in a given artery so that blood pressure does not have a direct influence on aneurysm size. No wall shear stress-derived hemodynamic variables are found to be related to aneurysm size. Discussion A study of multiple aneurysms from one individual offers a unique opportunity to examine various hemodynamic factors without selection biases. Aneurysms greater than 4 mm (Group 1) have a higher product of maximum WSS and area of low WSS; aneurysms smaller than 4 mm (Group 2) have a lower product of maximum WSS and area of low WSS. In addition, aneurysm size is linearly correlated with the flow rate at the parent artery in each group. PMID:27555981

  16. Gossypiboma mimicking posterior urethral stricture

    PubMed Central

    Kumar, Bindey; Kumar, Prem; Sinha, Sanjay Kumar; Sinha, Neelam; Hasan, Zaheer; Thakur, Vinit Kumar; Anand, Utpal; Priyadarshi, Rajiv Nayan; Mandal, Manish

    2013-01-01

    INTRODUCTION Foreign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASE Two cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSION Two cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSION In the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group. PMID:23500749

  17. Endovascular Repair of Descending Thoracic Aortic Aneurysm

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an assessment on endovascular repair of descending thoracic aortic aneurysm (TAA). Clinical Need Aneurysm is the most common condition of the thoracic aorta requiring surgery. Aortic aneurysm is defined as a localized dilatation of the aorta. Most aneurysms of the thoracic aorta are asymptomatic and incidentally discovered. However, TAA tends to enlarge progressively and compress surrounding structures causing symptoms such as chest or back pain, dysphagia (difficulty swallowing), dyspnea (shortness of breath), cough, stridor (a harsh, high-pitched breath sound), and hoarseness. Significant aortic regurgitation causes symptoms of congestive heart failure. Embolization of the thrombus to the distal arterial circulation may occur and cause related symptoms. The aneurysm may eventually rupture and create a life-threatening condition. The overall incidence rate of TAA is about 10 per 100,000 person-years. The descending aorta is involved in about 30% to 40% of these cases. The prognosis of large untreated TAAs is poor, with a 3-year survival rate as low as 25%. Intervention is strongly recommended for any symptomatic TAA or any TAA that exceeds twice the diameter of a normal aorta or is 6 cm or larger. Open surgical treatment of TAA involves left thoracotomy and aortic graft replacement. Surgical treatment has been found to improve survival when compared with medical therapy. However, despite dramatic advances in surgical techniques for performing such complex operations, operative mortality from centres of excellence are between 8% and 20% for elective cases, and up to 50% in patients requiring emergency operations. In addition, survivors of open surgical repair of TAAs may suffer from severe complications. Postoperative or postprocedural complications of descending TAA repair include paraplegia, myocardial infarction, stroke, respiratory failure, renal failure, and intestinal ischemia. The Technology Endovascular aortic aneurysm

  18. Hepatic artery aneurysm in corticosteroid-treated, adult Kawasaki's disease.

    PubMed

    Caputo, A E; Roberts, W N; Yee, Y S; Posner, M P

    1991-11-01

    We describe a single case of Kawasaki's disease (mucocutaneous lymph node syndrome) with the rare complication of a hepatic artery aneurysm which was surgically repaired. Unusual features include arterial aneurysmal formation in the hepatic arteries rather than in coronary arteries, the unusual morphology of the hepatic artery aneurysm, and the expansion of the aneurysm after corticosteroid therapy.

  19. Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Sugimoto, Kazutaka; Shirao, Satoshi; Koizumi, Hiroyasu; Inoue, Takao; Oka, Fumiaki; Maruta, Yuichi; Suehiro, Eiichi; Sadahiro, Hirokazu; Oku, Takayuki; Yoneda, Hiroshi; Ishihara, Hideyuki; Nomura, Sadahiro; Suzuki, Michiyasu

    2016-10-01

    Delayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. In this patient, a prolonged duration of CSD and elevation of PRx preceded delayed neurological deficit. Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH. PMID:27492947

  20. Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Sugimoto, Kazutaka; Shirao, Satoshi; Koizumi, Hiroyasu; Inoue, Takao; Oka, Fumiaki; Maruta, Yuichi; Suehiro, Eiichi; Sadahiro, Hirokazu; Oku, Takayuki; Yoneda, Hiroshi; Ishihara, Hideyuki; Nomura, Sadahiro; Suzuki, Michiyasu

    2016-10-01

    Delayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. In this patient, a prolonged duration of CSD and elevation of PRx preceded delayed neurological deficit. Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH.

  1. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms

    PubMed Central

    Hamasaki, Osamu; Ikawa, Fusao; Hidaka, Toshikazu; Kurokawa, Yasuharu; Yonezawa, Ushio

    2014-01-01

    Summary We evaluated the outcomes of endovascular or surgical treatment of ruptured vertebral artery dissecting aneurysms (VADAs), and investigated the relations between treatment complications and the development and location of the posterior inferior cerebellar artery (PICA). We treated 14 patients (12 men, two women; mean age, 56.2 years) with ruptured VADAs between March 1999 and June 2012 at our hospital. Six and eight patients had Hunt and Hess grades 1-3 and 4-5, respectively. Twelve patients underwent internal endovascular trapping, one underwent proximal endovascular occlusion alone, and one underwent proximal endovascular occlusion in the acute stage and occipital artery (OA)-PICA anastomosis and surgical trapping in the chronic stage. The types of VADA based on their location relative to the ipsilateral PICA were distal, PICA-involved, and non-PICA in nine, two, and three patients, respectively. The types of PICA based on their development and location were bilateral anterior inferior cerebellar artery (AICA)-PICA, ipsilateral AICA-PICA, extradural, and intradural type in one, two, two, and nine patients, respectively. Two patients with high anatomical risk developed medullary infarction, but their midterm outcomes were better than in previous reports. The modified Rankin scale indicated grades 0-2, 3-5, and 6 in eight, three, and three patients, respectively. A good outcome is often obtained in the treatment of ruptured VADA using internal endovascular trapping, except in the PICA-involved type, even with high-grade subarachnoid hemorrhage. Treatment of the PICA-involved type is controversial. The anatomical location and development of PICA may be predicted by complications with postoperative medullary infarction. PMID:24976093

  2. Ruptured Isolated Spinal Artery Aneurysms

    PubMed Central

    Gutierrez Romero, Diego; Batista, Andre Lima; Gentric, Jean Christoph; Raymond, Jean; Roy, Daniel; Weill, Alain

    2014-01-01

    Summary Isolated spinal artery aneurysms are exceedingly rare vascular lesions thought to be related to dissection of the arterial wall. We describe two cases presenting with spinal subarachnoid haemorrhage that underwent conservative management. In the first patient the radiculomedullary branch involved was feeding the anterior spinal artery at the level of D3 and thus, neither endovascular nor surgical approach was employed. Control angiography was performed at seven days and at three months, demonstrating complete resolution of the lesion. In our second case, neither the anterior spinal artery or the artery of Adamkiewicz could be identified during angiography, thus endovascular management was deemed contraindicated. Magnetic resonance imaging showed a stable lesion in the second patient. No rebleeding or other complications were seen. In comparison to intracranial aneurysms, spinal artery aneurysms tend to display a fusiform appearance and lack a clear neck in relation to the likely dissecting nature of the lesions. Due to the small number of cases reported, the natural history of these lesions is not well known making it difficult to establish the optimal treatment approach. Various management strategies may be supported, including surgical and endovascular treatment, but It would seem that a wait and see approach is also viable, with control angiogram and treatment decisions based on the evolution of the lesion. PMID:25496690

  3. Preemptive Medicine for Cerebral Aneurysms

    PubMed Central

    AOKI, Tomohiro; NOZAKI, Kazuhiko

    2016-01-01

    Most of cerebral aneurysms (CAs) are incidentally discovered without any neurological symptoms and the risk of rupture of CAs is relatively higher in Japanese population. The goal of treatments for patients with CAs is complete exclusion of the aneurysmal rupture risk for their lives. Since two currently available major treatments, microsurgical clipping and endovascular coiling, have inherent incompleteness to achieve cure of CAs with some considerable treatment risks, and there is no effective surgical or medical intervention to inhibit the formation of CAs in patients with ruptured and unruptured CAs, new treatment strategies with lower risk and higher efficacy should be developed to prevent the formation, growth, and rupture of CAs. Preemptive medicine for CAs should be designed to prevent or delay the onset of symptoms from CAs found in an asymptomatic state or inhibit the de novo formation of CAs, but we have no definite methods to distinguish rupture-prone aneurysms from rupture-resistant ones. Recent advancements in the research of CAs have provided us with some clues, and one of the new treatment strategies for CAs will be developed based on the findings that several inflammatory pathways may be involved in the formation, growth, and rupture of CAs. Preemptive medicine for CAs will be established with specific biomarkers and imaging modalities which can sensor the development of CAs. PMID:27053328

  4. Giant Serpentine Aneurysm of the Middle Cerebral Artery

    PubMed Central

    Lee, Seung Joo; Kwun, Byung Duk; Kim, Chang Jin

    2010-01-01

    Giant serpentine aneurysms are rare and have distinct angiographic findings. The rarity, large size, complex anatomy and hemodynamic characteristics of giant serpentine aneurysms make treatment difficult. We report a case of a giant serpentine aneurysm of the right middle cerebral artery (MCA) that presented as headache. Treatment involved a superficial temporal artery (STA)-MCA bypass followed by aneurysm resection. The patient was discharged without neurological deficits, and early and late follow-up angiography disclosed successful removal of the aneurysm and a patent bypass graft. We conclude that STA-MCA bypass and aneurysm excision is a successful treatment method for a giant serpentine aneurysm. PMID:20856671

  5. Idiopathic subvalvular aortic aneurysm masquerading as acute coronary syndrome.

    PubMed

    Natarajan, Balaji; Ramanathan, Sundar; Subramaniam, Natarajan; Janardhanan, Rajesh

    2016-01-01

    Subvalvular aneurysms are the least common type of left ventricular (LV) aneurysms and can be fatal. Subaortic LV aneurysms are much rarer than submitral LV aneurysms and mostly reported in infancy. They can be congenital or acquired secondary to infections, cardiac surgery or trauma. Here, we report a unique presentation of a large, idiopathic subaortic aneurysm in an adult masquerading as an acute coronary syndrome. Diagnosis was made with the help of a CT aortography. Aneurysm was surgically resected with good results. This case highlights the clinical presentation and management of subaortic aneurysms, an important differential for congenital aortic malformations. PMID:27591034

  6. [A cylinder aneurysm of a penile prosthesis].

    PubMed

    Pannek, J; Bartel, P; Göcking, K

    2011-07-01

    Herniation of a penile prosthesis (cylinder aneurysm) is an extremely rare complication of penile prosthesis surgery. We report the first case of such an aneurysm in a patient with spinal cord injury. The treatment of choice is surgical revision with replacement of the faulty device. Filling of the implanted system with contrast media facilitates preoperative diagnostic workup. PMID:21567276

  7. Two cases of giant serpentine aneurysm.

    PubMed

    Kumabe, T; Kaneko, U; Ishibashi, T; Kaneko, K; Uchigasaki, S

    1990-06-01

    Giant serpentine aneurysm (GSA) is an entity defined on radiological and pathological grounds as a giant, partially thrombosed aneurysm containing tortuous vascular channels. We have had the opportunity to study two patients with GSAs, which has allowed for a complete comparative anatomical and radiological study. This report emphasizes the etiology of the GSAs. Twenty-two patients with GSAs have been reported in the literature, of which pathological studies were done in 10. In most of these, the aneurysm was found to be filled with an organized thrombus, but in our patients the aneurysm was filled with relatively new clot. The aneurysm enlarged and a change in the tortuous vascular channel was observed over a period of 1 year in the first patient, whereas a globoid aneurysm developed into a GSA in the brief period of just 2 weeks in the second patient. This rapid transformation of a globoid aneurysm into a GSA is of particular interest when the etiology of GSAs is considered. Our patients therefore shed some interesting light on the possible pathophysiology of GSAs. That is, the bloodstream may change dynamically in a giant aneurysm and may become a serpentine channel under conditions that lead to a "Coanda effect." PMID:2362659

  8. The Helsinki Rat Microsurgical Sidewall Aneurysm Model

    PubMed Central

    Marbacher, Serge; Marjamaa, Johan; Abdelhameed, Essam; Hernesniemi, Juha; Niemelä, Mika; Frösen, Juhana

    2014-01-01

    Experimental saccular aneurysm models are necessary for testing novel surgical and endovascular treatment options and devices before they are introduced into clinical practice. Furthermore, experimental models are needed to elucidate the complex aneurysm biology leading to rupture of saccular aneurysms. Several different kinds of experimental models for saccular aneurysms have been established in different species. Many of them, however, require special skills, expensive equipment, or special environments, which limits their widespread use. A simple, robust, and inexpensive experimental model is needed as a standardized tool that can be used in a standardized manner in various institutions. The microsurgical rat abdominal aortic sidewall aneurysm model combines the possibility to study both novel endovascular treatment strategies and the molecular basis of aneurysm biology in a standardized and inexpensive manner. Standardized grafts by means of shape, size, and geometry are harvested from a donor rat's descending thoracic aorta and then transplanted to a syngenic recipient rat. The aneurysms are sutured end-to-side with continuous or interrupted 9-0 nylon sutures to the infrarenal abdominal aorta. We present step-by-step procedural instructions, information on necessary equipment, and discuss important anatomical and surgical details for successful microsurgical creation of an abdominal aortic sidewall aneurysm in the rat. PMID:25350840

  9. Lessons from Animal Models of Arterial Aneurysm

    PubMed Central

    Gertz, S. David; Mintz, Yoav; Beeri, Ronen; Rubinstein, Chen; Gilon, Dan; Gavish, Leah; Berlatzky, Yacov; Appelbaum, Liat; Gavish, Lilach

    2013-01-01

    We review the results from the most common animal models of arterial aneurysm, including recent findings from our novel, laparoscopy-based pig model of abdominal aortic aneurysm, that contribute important insights into early pathogenesis. We emphasize the relevance of these findings for evaluation of treatment protocols and novel device prototypes for mechanism-based prevention of progression and rupture. PMID:26798701

  10. Pantopaque simulating thrombosed intracranial aneurysms on MRI

    SciTech Connect

    Lidov, M.W.; Silvers, A.R.; Mosesson, R.E.; Stollman, A.L.; Som, P.M.

    1996-03-01

    A patient is presented in whom iophendylate (Pantopaque) within the basal cisterns closely resembled the appearance on MRI of thrombosed aneurysms of the middle cerebral arteries. The sometimes subtle differences between the appearances on MRI of Pantopaque and aneurysmal clot are discussed to permit accurate diagnosis without resorting to more invasive diagnostic tests, such as cerebral angiography. 5 refs., 4 figs.

  11. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    SciTech Connect

    Gonzalez Valverde, F.M. Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-04-15

    Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture.

  12. Anesthetic considerations in intracranial aneurysm surgery.

    PubMed

    Steen, Stephen N; Johnson, Calvin; Lumb, Phillip D; Zelman, Vladimer; Mok, Martin S

    2002-03-01

    Rupture of an intracranial aneurysm generally has a poor outcome, though perioperative treatments have improved. At the present time, the important factors in the management of intracranial aneurysm surgery appear to be the maintenance of adequate cerebral perfusion pressure and the avoidance of hyperglycemia. Relevant features of the anesthetic management of this surgery are discussed.

  13. Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses.

    PubMed

    Storey, Christopher; Menger, Richard; Hefner, Matthew; Keating, Patrick; Ahmed, Osama; Guthikonda, Bharat

    2015-11-01

    The purpose of our paper is to present a case of a rare complication of posterior lumbar surgery. Our patient presented for elective lumbar decompression, which was complicated by durotomy. She then developed sudden headache and right eye pain once upright on postoperative day 2. Then on postoperative day 3, she developed a dilated nonreactive pupil with extraocular movements intact. A computed tomography scan of the head was negative for subarachnoid hemorrhage. Magnetic resonance angiography showed a possible right posterior communicating artery aneurysm. She was transferred to a tertiary center with a severe headache and a nonreactive pupil, raising concern for evolving third nerve palsy due to aneurysm. A cerebral angiogram was performed and showed multiple aneurysms. Aneurysm location did not explain the patient's symptoms, and ophthalmology was consulted. Elevated intraocular pressure was noted, and the patient was diagnosed with acute angle-closure glaucoma (AACG). Our patient was medically treated and subsequently underwent laser peripheral iridotomy. She has had improved vision and pupillary function at 1 month follow-up. The diagnosis is complicated by a durotomy, which led to cascade in the differential diagnosis to rule out intracranial pathology. Her age and home medications, which had sympathomimetic effects, placed her at increased risk, but lying prone in the dark under the drapes was likely the lead causative factor. In conclusion, a postoperative posterior spine patient with eye pain and changes in vision and pupils should be evaluated with AACG in mind due to the devastating consequences if left untreated or treatment is delayed.

  14. Aneurysms of the visceral and renal arteries.

    PubMed Central

    Panayiotopoulos, Y. P.; Assadourian, R.; Taylor, P. R.

    1996-01-01

    Visceral aneurysms represent a rare clinical entity; however, 10-20% will rupture and this is accompanied by a significant mortality rate of 20-70%, depending on the location of the aneurysm. The incidence, pathogenesis and clinical aspects of splanchnic and renal artery aneurysms are reviewed from the available literature and the problems of diagnosis and treatment are discussed. Their incidence is increasing and controversy still exists regarding their treatment. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, surgery is advisable. An alternative treatment is the use of endovascular techniques, ie embolisation, or graft stent insertion. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 PMID:8881722

  15. Cerebral aneurysms: Formation, progression and developmental chronology

    PubMed Central

    Etminan, Nima; Buchholz, Bruce A.; Dreier, Rita; Bruckner, Peter; Torner, James C.; Steiger, Hans-Jakob; Hänggi, Daniel; Macdonald, R. Loch

    2015-01-01

    The prevalence of unruptured intracranial aneurysms (UAIs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of UIAs progress towards rupture over the lifetime of an individual, but the surrogates for subsequent rupture and the natural history of UIAs are discussed very controversially at present. In case of rupture of an UIA, the case-fatality is up to 50%, which therefore continues to stimulate interest in the pathogenesis of cerebral aneurysm formation and progression. Actual data on the chronological development of cerebral aneurysm has been especially difficult to obtain and, until recently, the existing knowledge in this respect is mainly derived from animal or mathematical models or short-term observational studies. Here, we highlight the current data on cerebral aneurysm formation and progression as well as a novel approach to investigate the developmental chronology of cerebral aneurysms. PMID:24323717

  16. Multiple fusiform cerebral aneurysms – case report

    PubMed Central

    Jaworska, Katarzyna; Dołowy, Joanna; Kuśmierska, Małgorzata; Kuniej, Tomasz; Jaźwiec, Przemysław

    2012-01-01

    Summary Background: A true aneurysym is a dilation of arterial lumen as a consequence of congenital or acquired abnormalities leading to a reduction of mechanical resistance of vascular wall, most commonly caused by its defected structure in the form of absence or weakening of the muscular and/or elastic layer. From the pathophysiological point of view, cerebral aneurysms can be classified as ‘saccular’ – most commonly occurring, and ‘other types’, including fusiform/dolichoectatic, dissecting, serpentine, posttraumatic, mycotic and giant aneurysms with or without intra-aneurysmal thrombosis. Case Report: We present a rare case of a patient with multiple fusiform dilations of cerebral vessels and giant fusiform aneurysm in supraclinoid segment of the internal carotid artery. The patient presented to hospital because of sudden, severe vertigo with nausea, impaired balance and disturbed vision. Vascular anomalies were detected on CT scanning without contrast. The diagnostic work-up was complemented by CT angiography, MRI and cerebral angiography. Conclusions: Aneurysm located within the intracranial arteries is one of the most common vascular defects of the brain. The number, size and location of aneurysms are highly variable. Aneurysms can have either supra- or infratentorial location, affecting a single or multiple arteries within one or both brain hemispheres. There is often a correlation between the location of the aneurysm and its etiology, as in case of so-called mirror-image aneurysms. Symmetrically located aneurysms may indicate a defect in vascular structure. Asymmetric location, as in the patient described above, is more likely due to acquired causes, mainly atherosclerosis, but also septic emboli or blood disorders. PMID:22802866

  17. Injuries of the posterior cruciate ligament.

    PubMed

    Moyer, R A; Marchetto, P A

    1993-04-01

    A review of the anatomy and biomechanics of the posterior cruciate ligament, and the systematic approach for the diagnosis and treatment of isolated posterior cruciate ligament injuries and posterior cruciate ligament insufficiency in combination with other ligamentous instabilities is discussed.

  18. β-Carotene Attenuates Angiotensin II-Induced Aortic Aneurysm by Alleviating Macrophage Recruitment in Apoe−/− Mice

    PubMed Central

    Gopal, Kaliappan; Nagarajan, Perumal; Jedy, Jose; Raj, Avinash T.; Gnanaselvi, S. Kalai; Jahan, Parveen; Sharma, Yogendra; Shankar, Esaki M.; Kumar, Jerald M.

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a common chronic degenerative disease characterized by progressive aortic dilation and rupture. The mechanisms underlying the role of α-tocopherol and β-carotene on AAA have not been comprehensively assessed. We investigated if α-tocopherol and β-carotene supplementation could attenuate AAA, and studied the underlying mechanisms utilized by the antioxidants to alleviate AAA. Four-months-old Apoe−/− mice were used in the induction of aneurysm by infusion of angiotensin II (Ang II), and were orally administered with α-tocopherol and β-carotene enriched diet for 60 days. Significant increase of LDL, cholesterol, triglycerides and circulating inflammatory cells was observed in the Ang II-treated animals, and gene expression studies showed that ICAM-1, VCAM-1, MCP-1, M-CSF, MMP-2, MMP-9 and MMP-12 were upregulated in the aorta of aneurysm-induced mice. Extensive plaques, aneurysm and diffusion of inflammatory cells into the tunica intima were also noticed. The size of aorta was significantly (P = 0.0002) increased (2.24±0.20 mm) in the aneurysm-induced animals as compared to control mice (1.17±0.06 mm). Interestingly, β-carotene dramatically controlled the diffusion of macrophages into the aortic tunica intima, and circulation. It also dissolved the formation of atheromatous plaque. Further, β-carotene significantly decreased the aortic diameter (1.33±0.12 mm) in the aneurysm-induced mice (β-carotene, P = 0.0002). It also downregulated ICAM-1, VCAM-1, MCP-1, M-CSF, MMP-2, MMP-9, MMP-12, PPAR-α and PPAR-γ following treatment. Hence, dietary supplementation of β-carotene may have a protective function against Ang II-induced AAA by ameliorating macrophage recruitment in Apoe−/− mice. PMID:23826202

  19. Aneurysmal Bone Cyst Presenting as a Pathologic Fracture in a 12-Year-Old Football Player

    PubMed Central

    Welk, Aaron B.; Norman W., Kettner

    2014-01-01

    Objective The purpose of this report is to describe a case of an aneurysmal bone cyst presenting as a pathologic fracture in a young athlete. Case report A 12-year-old patient presented to a chiropractic teaching clinic with a 1-week history of posterior neck pain and stiffness following a helmet-to-helmet collision in football practice. Cervical spine radiographs were taken. Lateral view radiograph demonstrated a pathologic fracture through a lytic, expansive lesion in the posterior arch of C7 with mild subluxation of the C7/T1 apophyseal joints and angulation of the C7/T1 disk space. Based upon these findings, additional diagnostic imaging was ordered. Findings on advanced imaging studies included the following: On computed tomography, the C7 lesion showed medullary destruction, cortical thinning and expansion, and a horizontally oriented fracture through the spinous and lamina. Magnetic resonance imaging studies for sagittal T2 and contrast-enhanced T1-weighted magnetic resonance images revealed fluid/fluid levels in the C7 spinous and peripheral enhancement with contrast. Outcome The patient was referred to a local hospital for treatment. The lesion was treated with resection of the posterior arch, and an aneurysmal bone cyst was confirmed histologically. The patient developed a kyphotic deformity at the site of resection and cervical instability. A subsequent fusion was performed. Conclusion Aneurysmal bone cysts are rare lesions. In this case, the initial traumatic history masked the underlying pathology. Although rare, pathologic fracture should be considered in cases of vertebral fracture in young patients. PMID:24711787

  20. Comparison of aesthetic posterior restorations.

    PubMed

    Trushkowsky, R D

    1991-09-01

    In the past decade there has been an increased desire by the profession and the public for an aesthetic restoration that will restore a posterior tooth to its original form and function. The currently available aesthetic posterior restoration materials and techniques are porcelain, cast ceramic, direct composite, direct-indirect composite, indirect composite, and CAD-CAM fabrications. The indications and contraindications of these restorative materials and proper diagnosis and case selection are described.

  1. [Repeated Rupture of Bilateral Internal Carotid Artery Aneurysms in a Short Period in Association with Polyarteritis Nodosa:A Case Report].

    PubMed

    Miura, Takanori; Maruya, Jun; Watanabe, Jun; Sato, Ryuta; Hatakeyama, Takashi; Nishimaki, Keiichi

    2016-08-01

    Cerebral involvement is rare in polyarteritis nodosa(PAN);furthermore, secondary intracranial hemorrhage due to cerebral aneurysm is extremely rare. We describe an unusual case of repeated subarachnoid hemorrhage(SAH)in a 64-year-old woman with a history of PAN. Initially, she developed severe headache(probable first SAH, day 0), and presented at our hospital with second severe headache with disturbed consciousness on day 6. Computed tomography(CT)revealed that SAH was mainly distributed in the right basal cistern and sylvian fissure(second SAH). Three aneurysms were detected using CT angiography on the bilateral internal carotid arteries. An intentionally delayed surgery was planned because of the high risk period of cerebral vasospasm and takotsubo cardiomyopathy. On day 15, she complained of headache and had a convulsion. CT revealed a third SAH in the left sylvian fissure;cerebral angiography revealed enlargement of the left internal carotid-posterior communicating artery(IC-PC)aneurysm. Coil embolization of the aneurysm was performed on day 16, and she was treated using prednisolone(20mg/day)for PAN. However, on day 20, the patient became comatose, and CT revealed a fourth SAH in the right sylvian fissure. Cerebral angiography revealed enlargement of the right IC-PC aneurysm. Clipping of the aneurysm was successfully performed in spite of ventricular dysfunction, and the dose of prednisolone was increased to 40mg/day. After treatment, the ventricular dysfunction gradually resolved. Cerebral aneurysms with PAN are candidates for intervention because of their strong tendency to rupture. In our case, takotsubo cardiomyopathy might have been associated with impairment of the coronary microcirculation due to PAN. We suggest that aggressive immunosuppressive treatment for PAN and curative treatments for cerebral aneurysms should be considered with careful radiological examination and follow-up monitoring. PMID:27506843

  2. The Influence of Dome Size, Parent Vessel Angle, and Coil Packing Density on Coil Embolization Treatment in Cerebral Aneurysms

    NASA Astrophysics Data System (ADS)

    Frakes, David H.; Indahlastari, Aprinda; Ryan, Justin; Babiker, M. Haithem; Nair, Priya; Parthas, Varsha

    2013-11-01

    Intracranial aneurysms (ICAs) are dilated cerebral blood vessels. Treating ICAs effectively prior rupture is crucial since their association with 45% mortality rate. Embolic coiling is the most effective ICA treatment. Series of embolic coils are deployed into the aneurysm with the intent of reaching a sufficient packing density (PD) to help seal off the ICA from circulation. While coiling is effective, treatment failures have been associated with basilar tip aneurysms (BTAs), perhaps because of their geometry. The aim of this study was to examine the effect of dome size, parent vessel (PV) angle, and PD on intraaneurysmal (IA) velocity, crossneck (CN) flow and low wall shear stress (WSS) area using simulations and experiments in idealized BTA models. IA velocity and CN flow decreased after coiling, while low WSS area increased. With increasing PD, IA velocity and CN flow were further reduced, but low WSS area had a minimal change. Coil PD had the greatest impact on post-treatment flow while dome size had a greater impact than PV angle. Overall, the role of aneurysmal geometries may vary depending on treatment goal and timing e.g., high coil PD may reduce IA velocity more effectively during early aneurysmal growth when the dome size is small. Funded by the American Heart Association.

  3. Physical Factors Effecting Cerebral Aneurysm Pathophysiology

    PubMed Central

    Sadasivan, Chander; Fiorella, David J.; Woo, Henry H.; Lieber, Baruch B.

    2013-01-01

    Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The distribution of cerebral aneurysms around the bifurcations of the circle of Willis has provided the impetus for numerous studies trying to link hemodynamic factors (flow impingement, pressure, and/or wall shear stress) to aneurysm pathophysiology. The focus of this review is to provide a broad overview of such hemodynamic associations as well as the subsumed aspects of vascular anatomy and wall structure. Hemodynamic factors seem to be correlated to the distribution of aneurysms on the intracranial arterial tree and complex, slow flow patterns seem to be associated with aneurysm growth and rupture. However, both the prevalence of aneurysms in the general population and the incidence of ruptures in the aneurysm population are extremely low. This suggests that hemodynamic factors and purely mechanical explanations by themselves may serve as necessary, but never as necessary and sufficient conditions of this disease’s causation. The ultimate cause is not yet known, but it is likely an additive or multiplicative effect of a handful of biochemical and biomechanical factors. PMID:23549899

  4. Physical factors effecting cerebral aneurysm pathophysiology.

    PubMed

    Sadasivan, Chander; Fiorella, David J; Woo, Henry H; Lieber, Baruch B

    2013-07-01

    Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The distribution of cerebral aneurysms around the bifurcations of the circle of Willis has provided the impetus for numerous studies trying to link hemodynamic factors (flow impingement, pressure, and/or wall shear stress) to aneurysm pathophysiology. The focus of this review is to provide a broad overview of such hemodynamic associations as well as the subsumed aspects of vascular anatomy and wall structure. Hemodynamic factors seem to be correlated to the distribution of aneurysms on the intracranial arterial tree and complex, slow flow patterns seem to be associated with aneurysm growth and rupture. However, both the prevalence of aneurysms in the general population and the incidence of ruptures in the aneurysm population are extremely low. This suggests that hemodynamic factors and purely mechanical explanations by themselves may serve as necessary, but never as necessary and sufficient conditions of this disease's causation. The ultimate cause is not yet known, but it is likely an additive or multiplicative effect of a handful of biochemical and biomechanical factors.

  5. Treatment of Descending Thoracic Aneurysm with an Intraaortic Occluder

    PubMed Central

    Liotta, Domingo; Frank, L.; Del Rio, M.; Gallo, A.; Navia, J.; Bertolozzi, E.; Bracco, D.; Cesareo, V.

    1987-01-01

    Elective treatment of descending thoracic aneurysms involves direct surgery, with Dacron graft replacement of the diseased aortic segment. When the patient's condition contraindicates major surgery, however, the surgeon should consider using an extraanatomic approach—implanting an ascending aorta-to-abdominal aorta Dacron bypass graft in a ventral position and leaving the diseased segment undisturbed. After such a procedure, the descending thoracic aorta must be excluded from the normal circulation. For this purpose, we have designed an intraaortic occluding technique in which an umbrella-like device is implanted immediately distal to the left subclavian artery. This technique has proved safe and uncomplicated in canine experiments and is ready for clinical trials. (Texas Heart Institute Journal 1987; 14:196-205) Images PMID:15229741

  6. Growth of basilar artery aneurysm after ventriculo-peritoneal shunt.

    PubMed

    Kim, Myoung Soo; Oh, Chang-Wan; Han, Dae Hee

    2002-11-01

    We report upon two cases of obstructive hydrocephalus produced by giant basilar artery aneurysms. They initially presented with symptoms of increased intracranial pressure, and were managed by a ventriculo-peritoneal (VP) shunt with good symptomatic improvement. With time, however, both showed a gradual deterioration of clinical symptoms due to increased aneurysm size. One, with a basilar tip aneurysm was treated by direct neck-clipping of the aneurysm, and was able to return to work. In the other patient, with a basilar trunk aneurysm, endovascular occlusion of one vertebral artery was attempted in an effort to decrease the aneurysm size, but the aneurysm enlarged precipitating brain stem failure. In conclusion, these cases reveal the risk of the VP shunt, which may induce aneurysmal growth, leading to clinical devastation, and emphasize the importance of definitive treatment for giant cerebral aneurysms whenever possible.

  7. Anterior ethmoidal artery aneurysm and intracerebral hemorrhage.

    PubMed

    da Costa, L B; Valiante, T; Terbrugge, K; Tymianski, M

    2006-09-01

    The association between the formation of intracranial aneurysms and situations of increased blood flow in certain areas of the brain is well accepted today. It has been seen in association with arteriovenous malformations of the brain, carotid occlusion, and Moyamoya disease. The occurrence of aneurysms in small arteries of the skull base, with the exception of the intracavernous carotid artery, however, is rare. We report a case of a 55-year-old woman who presented with an intracerebral hemorrhage caused by a ruptured anterior ethmoidal artery aneurysm. To the best of our knowledge, this is only the second case of documented intracranial bleeding from such a lesion.

  8. Giant aortic arch aneurysm complicating Kawasaki's disease

    PubMed Central

    Hakim, Kaouthar; Boussada, Rafik; Chaker, Lilia; Ouarda, Fatma

    2014-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was managed by steroids therapy in the beginning. Because of mechanical complication and potential risk of rupture, surgery was undertaken. PMID:25298695

  9. Ruptured cerebral aneurysm from choriocarcinoma.

    PubMed

    Wang, Jia; Wang, Rong; Zhao, Jizong

    2013-09-01

    Gestational trophoblastic diseases include hydatidiform moles, invasive moles, choriocarcinoma, placental-site trophoblastic tumours and miscellaneous trophoblastic lesions. Choriocarcinoma is a rare disease that arises from the trophoblastic epithelium of the placenta at the beginning of pregnancy. Among the confirmed cases, 45% occur after molar pregnancy, 25% after normal pregnancy, 25% after an abortion and 5% after ectopic pregnancy. This tumour is usually diagnosed based on its histopathologic appearance and a high level of serum beta-human chorionic gonadotropin (β-HCG). Choriocarcinoma exhibits a good response to chemotherapy and radiation. However, it is also known for its tendency to spread rapidly to multiple organs, including the lungs, liver and brain. As one of the worst prognostic factors, brain metastasis complicates 3-28% of gestational choriocarcinoma cases. Increased β-HCG levels and a low serum cerebrospinal fluid β-HCG level can be strongly suggestive of intracranial choriocarcinoma, even in the absence of histopathologically proven disease. Reviewing the literature, there were 23 cases of intracerebral haemorrhage from an oncotic aneurysm as an initial presentation of choriocarcinoma. We report a further case of intracerebral haematoma secondary to oncotic aneurysm as the first presentation of metastatic choriocarcinoma with normal serum β-HCG.

  10. Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage in Behcet Syndrome

    PubMed Central

    Kim, Jun Hak; Lee, Si-Un; Huh, Choonwoong; Oh, Chang Wan; Bang, Jae Seung

    2016-01-01

    A man visited the emergency room with a headache. Brain computed tomography showed aneurysmal subarachnoid hemorrhage (SAH) and multiple aneurysms. After aneurysm clipping surgery, the patient was discharged. After 5 days, he was admitted to the hospital with skin ulceration and was diagnosed with Behcet syndrome. An angiogram taken 7 weeks after aneurysmal SAH showed intracranial vasospasm. Because inflammation in Behcet syndrome may aggravate intracranial vasospasm, intracranial vasospasm after aneurysmal SAH in Behcet syndrome should be monitored for longer compared to general aneurysmal SAH. PMID:27114963

  11. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    PubMed

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

    2011-02-01

    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  12. Cognitive problems related to vertebrobasilar circulation.

    PubMed

    Koçer, Abdulkadir

    2015-01-01

    Neurodegenerative disorders are characterized by decreased regional cerebral blood flow. Supporting this concept, both cognitive training exercises and physical activity promote blood flow increase and correlate with healthy cognitive aging. The terminal branches of the posterior circulation supply blood to areas of the brain, such as the thalamus, hippocampus, occipital lobe, and cerebellum, involved with important intellectual functions, particularly recent memory, visual-spatial functioning, and visuomotor adaptations. Amnesia and visual agnosia may be a complication of not only posterior circulation infarctions but also vertebrobasilar insufficiency (VBI) without accompanying structural infarcts. The cognitive impairment maybe a manifestation of transient attacks and may persist beyond resolution of symptoms related to ischemia. Early recognition of cognitive deficits in the VBI patient is important because several recent reports show stent placements or medical treatment may improve cognition. PMID:26738337

  13. [Trapping of large and giant paraclinoid aneurysm based on intraoperative flowmetry test].

    PubMed

    Shekhtman, O D; Eliava, Sh Sh; Pilipenko, Yu I

    2014-01-01

    Four cases of giant or large paraclinoid aneurysms of the internal carotid artery successfully trapped after assessing blood flow using a flowmeter are presented. In all cases, the initial plan for clipping was changed to aneurysm trapping due to various reasons. The collateral blood flow was assessed using the flowmetry test, the original procedure of measuring volumetric blood flow in the middle cerebral artery using an ultrasonic flowmeter. We analyze the reasons for clipping refusal, the procedure of measuring blood flow, treatment outcomes, and catamnestic data. The risks of reconstructive surgeries involving the internal carotid artery are discussed and the literature data are analyzed. Conclusions. Ultrasonic flowmetry is a simple and safe method for intraoperative control over blood circulation, which may play the key role in complicated surgical cases. PMID:25406904

  14. Microsurgical technique of symptomatic intracavernous aneurysm.

    PubMed

    Liao, Chih-Hsiang; Lin, Chun-Fu; Hsu, Sanford P C; Chen, Min-Hsiung; Shih, Yang-Hsin

    2015-07-01

    Symptomatic intracavernous aneurysm is rare. Cranial nerves in the cavernous sinus are subjected to the mass effect of an expanding aneurysm. Microsurgical clipping is the treatment of choice to relieve compressive cranial neuropathy. In this video, the authors present a case of intracavernous aneurysm causing diplopia, ptosis, and facial numbness. The patient was operated on via a pretemporal transclinoid-transcavernous approach. The aneurysm was completely obliterated through direct clipping. There were no new-onset neurologic deficits and complications after the operation. Complete recovery of the diplopia, ptosis, and facial numbness was observed at the 6-month postoperative follow up. The video can be found here: http://youtu.be/4w5QUoNIAQM. PMID:26132609

  15. A fibromatosis case mimicking abdominal aorta aneurysm.

    PubMed

    Tasdemir, Arzu; Kahraman, Cemal; Tasdemir, Kutay; Mavili, Ertugrul

    2013-01-01

    Retroperitoneal fibrosis is a rare fibrosing reactive process that may be confused with mesenteric fibromatosis. Abdominal aorta aneurysm is rare too and mostly develops secondary to Behcet's disease, trauma, and infection or connective tissue diseases. Incidence of aneurysms occurring as a result of atherosclerotic changes increases in postmenopausal period. Diagnosis can be established with arteriography, tomography, or magnetic resonance imaging associated with clinical findings. Tumors and cysts should be considered in differential diagnosis. Abdominal ultrasound and contrast-enhanced computerized tomography revealed an infrarenal abdominal aorta aneurysm in a 41-year-old woman, but, on surgery, retroperitoneal fibrosis surrounding the aorta was detected. We present this interesting case because retroperitoneal fibrosis encircling the abdominal aorta can mimic abdominal aorta aneurysm radiologically.

  16. Giant intracranial aneurysms: rapid sequential computed tomography

    SciTech Connect

    Pinto, R.S.; Cohen, W.A.; Kricheff, I.I.; Redington, R.W.; Berninger, W.H.

    1982-11-01

    Giant intracranial aneurysms often present as mass lesions rather than with subarachnoid hemorrhage. Routine computed tomographic (CT) scans with contrast material will generally detect them, but erroneous diagnosis of basal meningioma is possible. Rapid sequential scanning (dynamic CT) after bolus injection of 40 ml of Renografin-76 can conclusively demonstrate an intracranial aneurysm, differentiating it from other lesions by transit-time analysis of the passage of contrast medium. In five patients, the dynamics of contrast bolus transit in aneurysms were consistently different from the dynamics in pituitary tumors, craniopharyngiomas, and meningiomas, thereby allowing a specific diagnosis. Dynamic CT was also useful after treatment of the aneurysms by carotid artery ligation and may be used as an alternative to angiographic evaluation in determining luminal patency or thrombosis.

  17. Endovascular repair of thoracic aortic aneurysm

    PubMed Central

    Akin, Ibrahim; Kische, Stephan; Rehders, Tim C.; Nienaber, Christoph A.; Rauchhaus, Mathias

    2010-01-01

    A thoracic aortic aneurysm (TAA) is a potentially life-threatening condition with structural weakness of the aortic wall, which can progress to arterial dilatation and rupture. Today, both an increasing awareness of vascular disease and the access to tomographic imaging facilitate the diagnosis of TAA even in an asymptomatic stage. The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture. Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture. While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes. PMID:22419919

  18. Children's understanding of posterior probability.

    PubMed

    Girotto, Vittorio; Gonzalez, Michel

    2008-01-01

    Do young children have a basic intuition of posterior probability? Do they update their decisions and judgments in the light of new evidence? We hypothesized that they can do so extensionally, by considering and counting the various ways in which an event may or may not occur. The results reported in this paper showed that from the age of five, children's decisions under uncertainty (Study 1) and judgments about random outcomes (Study 2) are correctly affected by posterior information. From the same age, children correctly revise their decisions in situations in which they face a single, uncertain event, produced by an intentional agent (Study 3). The finding that young children have some understanding of posterior probability supports the theory of naive extensional reasoning, and contravenes some pessimistic views of probabilistic reasoning, in particular the evolutionary claim that the human mind cannot deal with single-case probability. PMID:17391661

  19. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes.

  20. Cerebellar hemangioblastoma mimicking an aneurysm: A case report and literature review

    PubMed Central

    Ji, Yu-Chen; Li, Yan; Hu, Jing-Xia; Zhang, Hong-Bo; Yan, Peng-Xiang; Zuo, Huan-Cong

    2016-01-01

    Hemangioblastomas (HBMs) are highly vascular tumors of the central nervous system. Sporadic HBMs are nearly always solitary, and solitary HBMs are similar to intracranial arteriovenous malformations due to their highly vascular characteristics. However, to the best of our knowledge, cases of HBM in the cerebellum mimicking an aneurysm have never been reported in the literature. The present study reports a case of an HBM on the right cerebellar hemisphere mimicking an aneurysm, which originated from the right posterior inferior cerebellar artery, as determined using magnetic resonance angiography and digital subtraction angiography. The patient was admitted the Department of Neurosurgery at the Tsinghua University Yuquan Hospital (Beijing, China) in January 2015 due to a 4-year history of intermittent headaches. The diagnosis of an HBM was determined during surgery and the tumor was totally resected by changing the operation technique, with no complications. In conclusion, it is difficult to distinguish between HBMs and intracranial vascular diseases, particularly aneurysms. Surgeons should consider the possibility carefully prior to surgery and careful prepare for each eventuality.

  1. Cerebellar hemangioblastoma mimicking an aneurysm: A case report and literature review

    PubMed Central

    Ji, Yu-Chen; Li, Yan; Hu, Jing-Xia; Zhang, Hong-Bo; Yan, Peng-Xiang; Zuo, Huan-Cong

    2016-01-01

    Hemangioblastomas (HBMs) are highly vascular tumors of the central nervous system. Sporadic HBMs are nearly always solitary, and solitary HBMs are similar to intracranial arteriovenous malformations due to their highly vascular characteristics. However, to the best of our knowledge, cases of HBM in the cerebellum mimicking an aneurysm have never been reported in the literature. The present study reports a case of an HBM on the right cerebellar hemisphere mimicking an aneurysm, which originated from the right posterior inferior cerebellar artery, as determined using magnetic resonance angiography and digital subtraction angiography. The patient was admitted the Department of Neurosurgery at the Tsinghua University Yuquan Hospital (Beijing, China) in January 2015 due to a 4-year history of intermittent headaches. The diagnosis of an HBM was determined during surgery and the tumor was totally resected by changing the operation technique, with no complications. In conclusion, it is difficult to distinguish between HBMs and intracranial vascular diseases, particularly aneurysms. Surgeons should consider the possibility carefully prior to surgery and careful prepare for each eventuality. PMID:27698835

  2. Radiographic imaging of the distal dural ring for determining the intradural or extradural location of aneurysms.

    PubMed

    Beretta, Federica; Sepahi, Ali Nader; Zuccarello, Mario; Tomsick, Thomas A; Keller, Jeffrey T

    2005-11-01

    The effectiveness of several anatomical and radiological landmarks proposed to determine whether an aneurysm is located intradurally or extradurally is still debated. In anatomical and radiological studies, we examined the relationships of the distal dural ring (DDR) to the internal carotid artery (ICA) and surrounding bony structures to aid in the localization of aneurysms near the DDR. Anatomical relationships were examined by performing dissections on 10 specimens (5 formalin-fixed cadaveric heads). After the position of the DDR, optic nerve, and tuberculum sellae were marked with surgical steel wire, radiographs were taken in multiple projections. The only bony landmark consistently visible on radiographs was the planum sphenoidale. The superior border of the DDR is located at or below the level of the tuberculum sellae, which laterally becomes the superomedial aspect of the optic strut; thus, the optic strut marks the dorsal limit of the DDR. On 50 dry skulls, we measured the vertical distance between the planum sphenoidale and medial aspect of the optic strut (5.0 +/- 0.4 mm), the interoptic strut distance (14.4 +/- 1.4 mm), and the linear distance between the most posterior aspect of the planum sphenoidale (limbus sphenoidale) and the tuberculum sellae (6.0 +/- 0.5 mm). Using these measurements and the planum sphenoidale, tuberculum sellae, and optic strut as reference landmarks, we determined the location of the aneurysm relative to the DDR on angiographic images. In this way, we were able to identify whether lesions were intra- or extradural. PMID:16648887

  3. Multiple tuberculous aneurysms of the aorta.

    PubMed

    Pierret, Charles; Tourtier, Jean-Pierre; Grand, Bertrand; Boddaert, Guillaume; Laurian, Claude; de Kerangal, Xavier

    2011-06-01

    Tuberculous aneurysms of the aorta are quite rare, but are exceptional when found in multiple locations. We report the case of multiple tuberculous aortic aneurysms of the thoracic and abdominal aorta in a 19-year-old female discovered when she consulted for thrombocytopenic purpura. The treatment for both locations included prolonged antituberculous therapy and surgical resection with cryopreserved aortic allograft patch for the reconstruction.

  4. Aneurysmal portosystemic venous shunt: a case report.

    PubMed

    Bodner, G; Glück, A; Springer, P; König, P; Perkmann, R

    1999-10-01

    A case of an aneurysmal portosystemic venous shunt detected by colour Doppler ultrasound (CDUS) is presented. A young female patient complained of postprandial fatigue and had paroxysmal tachycardia. A direct vascular communication between right portal vein and right hepatic vein was found at CDUS and confirmed by direct portal angiogram. Using detachable coils a complete occlusion of the intrahepatic shunt was obtained. Reports from the literature regarding portovenous aneurysms are reviewed.

  5. Multiple Intracranial Aneurysms in HIV Infection.

    PubMed

    Dhawan, Sumeet R; Gupta, Anju; Gupta, Vivek; Singhi, Pratibha D

    2016-08-01

    Neurological findings in HIV are common and include cognitive impairment, microcephaly, nonspecific white matter lesions and seizures. Cerebral vasculopathy and stroke are uncommon and may be due to primary HIV vasculopathy or opportunistic infections such as tuberculosis and cryptococcal meningitis. The authors describe a 7-y-old boy who presented with severe headache and was detected to have aneurysmal bleed due to intracranial aneurysm. PMID:27072660

  6. Direct clipping of large basilar trunk aneurysm.

    PubMed

    Kimura, Toshikazu; Nakagawa, Daichi; Kawai, Kensuke

    2015-01-01

    A large basilar trunk aneurysm was incidentally found in a 77-year-old woman in examination for headache. Though it was asymptomatic, high signal intensity was noticed in the brainstem around the aneurysm on FLAIR image of MRI. As she was otherwise healthy, surgical clipping was performed through anterior temporal approach. The video can be found here: http://youtu.be/0soWM8meCW8 . PMID:25554839

  7. Management strategy for bilateral complex vertebral artery aneurysms.

    PubMed

    Saito, Norihiro; Kamiyama, Hiroyasu; Takizawa, Katsumi; Takebayashi, Seiji; Asano, Takeshi; Kobayashi, Tohru; Kobayashi, Rina; Kubota, Shunsuke; Ito, Yasuhiro; Karagiozov, Kostadin L

    2016-04-01

    Bilateral complex vertebral artery aneurysms (BCoVAAns) have no established strategy of management. We retrospectively reviewed five consecutive patients with unruptured BCoVAAns between January 2006 and December 2012. Considering surgical risks of lower cranial nerve (LCN) injuries and eventual growth of an opposite side lesion after unilateral vertebral artery (VA) occlusion, we proposed a strategy of combined open and interventional treatment using revascularization. We applied the following several specific techniques: (1) proximal clipping and occipital artery-posterior inferior cerebellar artery (OA-PICA) and/or superficial temporary artery (STA)-superior cerebellar artery (SCA) bypasses; (2) Distal blood pressure, motor evoked potentials (MEPs), and somatosensory evoked potentials (SEPs) monitoring after parent artery temporary occlusion for safe permanent occlusion of the proximal portions of VA and PICA; (3) V3 to V4 bypass using radial artery (RA) graft with proximal clipping or trapping, two of them combined with OA-PICA bypass; (4) VA fenestration as an opportunity to preserve the flow of the parent artery. Two patients were treated bilaterally and 3 unilaterally, with modified Rankin scale assessed at 39 months postoperatively in average 0 in 2, 1 in 2, and 2 in 1, respectively, and the untreated opposite side lesions without regrowth or bleeding. Two patients with patent V3-RA-V4 bypass complained of dysphagia due to LCN palsies. One of them however suffered a cerebellar infarction due to occlusion of the OA-PICA bypass. When BCoVAAns require surgical treatment, revascularization or preservation of the VA should be considered at the first operation. By doing so, the opposite aneurysm can be effectively occluded by coil embolization, even with VA sacrifice if required. PMID:26564148

  8. Unsuccessful outcomes after posterior urethroplasty.

    PubMed

    Engel, Oliver; Fisch, Margit

    2015-03-01

    Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a common reason for urethral strictures caused by road traffic accidents, with pelvic fracture or direct trauma to the perineum. In many cases early endoscopic realignment is the first attempt to restore the junction between proximal and distal urethra, but in some cases primary realignment is not possible or not enough to treat the urethral injury. In these cases suprapubic cystostomy alone and delayed repair by stricture excision and posterior urethroplasty is an alternative procedure to minimise the risk of stricture recurrence.

  9. Non coding RNAs in aortic aneurysmal disease

    PubMed Central

    Duggirala, Aparna; Delogu, Francesca; Angelini, Timothy G.; Smith, Tanya; Caputo, Massimo; Rajakaruna, Cha; Emanueli, Costanza

    2015-01-01

    An aneurysm is a local dilatation of a vessel wall which is >50% its original diameter. Within the spectrum of cardiovascular diseases, aortic aneurysms are among the most challenging to treat. Most patients present acutely after aneurysm rupture or dissection from a previous asymptomatic condition and are managed by open surgical or endovascular repair. In addition, patients may harbor concurrent disease contraindicating surgical intervention. Collectively, these factors have driven the search for alternative methods of identifying, monitoring and treating aortic aneurisms using less invasive approaches. Non-coding RNA (ncRNAs) are emerging as new fundamental regulators of gene expression. The small microRNAs have opened the field of ncRNAs capturing the attention of basic and clinical scientists for their potential to become new therapeutic targets and clinical biomarkers for aortic aneurysm. More recently, long ncRNAs (lncRNAs) have started to be actively investigated, leading to first exciting reports, which further suggest their important and yet largely unexplored contribution to vascular physiology and disease. This review introduces the different ncRNA types and focus at ncRNA roles in aorta aneurysms. We discuss the potential of therapeutic interventions targeting ncRNAs and we describe the research models allowing for mechanistic studies and clinical translation attempts for controlling aneurysm progression. Furthermore, we discuss the potential role of microRNAs and lncRNAs as clinical biomarkers. PMID:25883602

  10. Juxtarenal aortic aneurysm: endoluminal transfemoral repair?

    PubMed

    Ferko, A; Krajina, A; Jon, B; Lesko, M; Voboril, Z; Zizka, J; Eliás, P

    1997-01-01

    Endoluminal transfemoral repair of an abdominal aortic aneurysm by a stent graft placement requires a segment of the nondilated infrarenal aorta of at least 15 mm long for safe stent graft attachment. The possibility of endoluminal treatment of a juxtarenal abdominal aortic aneurysm with partially covered spiral Z stent was assessed in experiment and in three clinical cases. In the experiment, the noncovered spiral Z stent was placed into the abdominal aorta, across the origins of renal arteries and mesenteric arteries, in six dogs. In the clinical cases, a partially covered stent graft was attached in 3 patients with the juxtarenal abdominal aortic aneurysm (of the group of 12 patients with abdominal aortic aneurysm). The stent grafts were attached with proximal uncovered parts across the origins of the renal arteries. In experiment, the renal artery occlusions or stenoses were not observed 36 months after stent placement, and in clinic, 3 patients with the juxtarenal aortic aneurysm were successfully treated by stent graft placement. There were no signs of flow impairment into the renal arteries 14 months after stent graft implantation. This approach can possibly expand the indications for endoluminal grafting in the treatment of juxtarenal aortic aneurysms in patients who are at high risk for surgery.

  11. Biology of intracranial aneurysms: role of inflammation

    PubMed Central

    Chalouhi, Nohra; Ali, Muhammad S; Jabbour, Pascal M; Tjoumakaris, Stavropoula I; Gonzalez, L Fernando; Rosenwasser, Robert H; Koch, Walter J; Dumont, Aaron S

    2012-01-01

    Intracranial aneurysms (IAs) linger as a potentially devastating clinical problem. Despite intense investigation, our understanding of the mechanisms leading to aneurysm development, progression and rupture remain incompletely defined. An accumulating body of evidence implicates inflammation as a critical contributor to aneurysm pathogenesis. Intracranial aneurysm formation and progression appear to result from endothelial dysfunction, a mounting inflammatory response, and vascular smooth muscle cell phenotypic modulation producing a pro-inflammatory phenotype. A later final common pathway appears to involve apoptosis of cellular constituents of the vessel wall. These changes result in degradation of the integrity of the vascular wall leading to aneurysmal dilation, progression and eventual rupture in certain aneurysms. Various aspects of the inflammatory response have been investigated as contributors to IA pathogenesis including leukocytes, complement, immunoglobulins, cytokines, and other humoral mediators. Furthermore, gene expression profiling of IA compared with control arteries has prominently featured differential expression of genes involved with immune response/inflammation. Preliminary data suggest that therapies targeting the inflammatory response may have efficacy in the future treatment of IA. Further investigation, however, is necessary to elucidate the precise role of inflammation in IA pathogenesis, which can be exploited to improve the prognosis of patients harboring IA. PMID:22781330

  12. Bronchial Artery Aneurysm Embolization with NBCA

    SciTech Connect

    Aburano, Hiroyuki Kawamori, Yasuhiro; Horiti, Yasushi; Kitagawa, Kiyohide; Sanada, Junichiro; Matsui, Osamu

    2006-12-15

    We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not.

  13. A Large Posttraumatic Subclavian Artery Aneurysm Complicated by Artery Occlusion and Arteriobronchial Fistula Successfully Treated Using a Covered Stent

    SciTech Connect

    Stefanczyk, Ludomir; Czeczotka, Jaroslaw; Elgalal, Marcin; Sapieha, Michal; Rowinski, Olgierd

    2011-02-15

    The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.

  14. False-negative indocyanine green videoangiography among complex unruptured middle cerebral artery aneurysms: the importance of further aneurysm inspection.

    PubMed

    Kulwin, Charles; Cohen-Gadol, Aaron A

    2014-10-01

    Successful surgical treatment of cerebral aneurysms requires complete occlusion of the aneurysm lumen while maintaining patency of the adjacent branching and perforating arteries. Intraoperative flow assessment allows aneurysm clip repositioning in the event these requirements are not met, avoiding the risk of postoperative rehemorrhage or infarction. A number of modalities have been proposed for primarily intraoperative qualitative blood flow assessment, including microdoppler ultrasonography, intraoperative digital subtraction angiography (DSA), and more recently noninvasive fluorescent angiography including indocyanine green (ICG) fluorescent imaging. Puncture of the aneurysm dome to exclude aneurysm sac filling may also assess the efficacy of clip placement. Although a high concordance between ICG and DSA has been reported, there remains an important subset of aneurysms for which negative ICG study may erroneously suggest aneurysm occlusion. A high-risk situation for such a false-negative study is an atherosclerotic middle cerebral artery (MCA) aneurysm in which vessel wall plaque interferes with the ICG signal. Furthermore, a decreased flow within the aneurysm may not allow enough emission light for detection under the current technology. In this report, we describe our experience with cases of MCA aneurysms with false-negative ICG-VA studies requiring clip adjustment for optimal surgical treatment and discuss two illustrative cases of MCA aneurysms with intraoperative fluorescence studies that were falsely negative, requiring puncture of the aneurysm to correctly identify incomplete aneurysm occlusion. PMID:24552255

  15. Talk to Your Doctor about Abdominal Aortic Aneurysm

    MedlinePlus

    ... español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics Overview What is AAA? ... doctor about getting screened (tested) for abdominal aortic aneurysm (AAA). If AAA isn't found and treated ...

  16. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    MedlinePlus

    ... Home Health Conditions familial TAAD familial thoracic aortic aneurysm and dissection Enable Javascript to view the expand/ ... Open All Close All Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the ...

  17. The experimental study on aneurysm with PIV system

    NASA Astrophysics Data System (ADS)

    Yueshe, Wang; Xiaoqi, Ma; Di, Li

    2013-07-01

    Cerebral aneurysm, a local enlargement of an artery caused by weakness in the wall of a cerebral artery, has the high death rate and disability rate, and is a threat to public health. The forming mechanism of aneurysm is complex, which motivated many researchers to conduct studies in this field. The results indicated that increasing heart frequency can aggravate the oscillation of wall shear stress, and push The growth points of aneurysm along the aneurysm wall, thereby significantly affecting bthe growth and rupture mechanism of aneurysm. In addition, it is found that the curvature of the vessel is the key to induce the secondary vortex in the aneurysm; the secondary vortex increases the magnitude of WSS near the dome of aneurysm, which can cause the rupture of aneurysm dome. there is a linear relationship between the velocity of blood flow and the square root of hear frequency.

  18. Aneurysm of the internal carotid artery after minor trauma.

    PubMed

    Laissaoui, Younès; Noureddine El Alami, Mohamed

    2014-01-01

    We report a rare case of posttraumatic aneurysm of the internal carotid artery. The aneurysm was surgically removed, followed by a simple postoperative course. Such lesions should be highly suspected in cases of penetration into the retroangulomandibular neck region.

  19. Traumatic aneurysm of the superficial temporal artery from fist injury.

    PubMed

    Andreoli, A; Tognetti, F; Lanzino, G

    1990-01-01

    A case of traumatic aneurysm of the superficial temporal artery (STA) from fist injury during a basketball game is described. The published cases of STA aneurysms secondary to sport trauma and their diagnosis and treatment are reviewed.

  20. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171056

  1. Neonatal posterior fossa subdural hematoma.

    PubMed

    Coker, S; Beltran, R; Fine, M

    1987-07-01

    Hemorrhage into the posterior fossa is a rare neurosurgical emergency in neonates. CT scanning is diagnostic. Blood layering under the apex of the tentorium cerebelli, however, may resemble a dilated vascular structure, and the rigidity of the pressured tentorium may prevent upward transmission of increased intracranial pressure, resulting in a soft fontanelle.

  2. Management of Splenic Artery Aneurysms and False Aneurysms with Endovascular Treatment in 12 Patients

    SciTech Connect

    Guillon, R.; Garcier, J.M.; Abergel, A.; Mofid, R.; Garcia, V.; Chahid, T.; Ravel, A.; Pezet, D.; Boyer, L.

    2003-06-15

    Purpose: To assess the endovascular treatment of splenic artery aneurysms and false aneurysms. Methods: Twelve patients (mean age 59 years, range 47-75 years) with splenic artery aneurysm (n = 10) or false aneurysm (n = 2) were treated. The lesion was asymptomatic in 11 patients; hemobilia was observed in one patient. The lesion was juxta-ostial in one case, located on the intermediate segment of the splenic artery in four, near the splenic hilus in six,and affected the whole length of the artery in one patient. In 10 cases, the maximum lesion diameter was greater than 2 cm; in one case 30% growth of an aneurysm 18 mm in diameter had occurred in 6 months;in the last case, two distal aneurysms were associated (17 and 18 mm in diameter). In one case, stent-grafting was attempted; one detachable balloon occlusion was performed; the 10 other patients were treated with coils. Results: Endovascular treatment was possible in 11 patients (92%) (one failure: stenting attempt). In four cases among 11, the initial treatment was not successful (residual perfusion of aneurysm); surgical treatment was carried out in one case, and a second embolization in two. Thus in nine cases (75%) endovascular treatment was successful: complete and persistent exclusion of the aneurysm but with spleen perfusion persisting at the end of follow-upon CT scans (mean 13 months). An early and transient elevation of pancreatic enzymes was observed in four cases. Conclusion: Ultrasound and CT have made the diagnosis of splenic artery aneurysm or false aneurysm more frequent. Endovascular treatment, the morbidity of which is low, is effective and spares the spleen.

  3. Blister-like aneurysms of middle cerebral artery: a multicenter retrospective review of diagnosis and treatment in three patients.

    PubMed

    Peschillo, Simone; Missori, P; Piano, M; Cannizzaro, D; Guidetti, G; Santoro, A; Cenzato, M

    2015-01-01

    Blood blister-like aneurysms (BBA) were described for the first time in the 1990s, as small hemispherical bulges arising from a very fragile arterial wall. Until 2008, it was thought that this type of aneurysm almost exclusively affected the internal carotid artery, in particular, its dorsal portion. Subsequently, it was discovered that a BBA may also be present on the anterior communicating artery and on the vessels of the posterior cranial fossa. However, we found no reports in English-language literature of BBA arising from the middle cerebral artery (MCA). In this article, we present three cases of MCA BBA and discuss the unique diagnostic and therapeutic aspects of this vascular lesion. In our retrospective, multicenter review of 1330 patients with non-traumatic subarachnoid hemorrhage admitted to our services from 2000 to 2013, we found three cases (all in men) of MCA BBA. The patients' outcome was assessed using the modified Rankin scale. All three patients underwent angio-computed tomography, which did not reveal any aneurysms. Digital subtraction angiography performed within 24-48 h after admission, in all cases, demonstrated a very small aneurysm (<2 mm), with a triangular shape and abroad base, at non-branching sites of MCA. All the aneurysms were treated: one by wrapping + clipping, one by wrapping + flow-diverter stent, and one with coils. At the time of surgery, the aneurysms appeared on the surface of the parent artery without any involvement of the branches. All presented as blister-like aneurysms that were thin-walled and lacked a surgical neck. At the time of discharge, the outcome was good in one patient and poor in the other two. Our cases demonstrate that BBA can also arise from the MCA, despite the lack of previous reports of this occurrence; a BBA should be suspected, particularly in cases of non-perimesencephalic subarachnoid hemorrhage in which the presence of a MCA aneurysm is suspected but not revealed by digital subtraction angiography

  4. Traumatic aneurysms of the intracranial and cervical vessels: A review.

    PubMed

    Bhaisora, Kamlesh S; Behari, Sanjay; Godbole, Chaitanya; Phadke, Rajendra V

    2016-01-01

    Traumatic intracranial aneurysms (TICA) are rare in occurrence, constituting less than 1% of the total cases of intracranial aneurysms. Cervical posttraumatic aneurysms arising from major blood vessels supplying the brain are also extremely rare. Their variable locations, morphological variations and the presence of concomitant head injury makes their diagnosis and treatment a challenge. In this review, we discuss the epidemiology, etiology, classification and management issues related to TICA as well as traumatic neck aneurysms and review the pertinent literature.

  5. A Case of Lateral Medullary Infarction after Endovascular Trapping of the Vertebral Artery Dissecting Aneurysm

    PubMed Central

    Cho, In Yong

    2012-01-01

    We report an unusual case of lateral medullary infarction after successful embolization of the vertebral artery dissecting aneurysm (VADA). A 49-year-old man who had no noteworthy previous medical history was admitted to our hospital with a severe headache. Computed tomography (CT) revealed a subarachnoid hemorrhage, located in the basal cistern and posterior fossa. Cerebral angiography showed a VADA, that did not involve the origin of the posterior inferior cerebellar artery (PICA). We treated this aneurysm via endovascular trapping of the vertebral artery distal to the PICA. After operation, CT revealed post-hemorrhagic hydrocephalus, which we resolved with a permanent ventriculoperitoneal shunt procedure. Postoperatively, the patient experienced transient mild hoarsness and dysphagia. Magnetic resonance image (MRI) showed a small infarction in the right side of the medulla. The patient recovered well, though he still had some residual symptom of dysphagia at discharge. Such an event is uncommon but can be a major clinical concern. Further investigation to reveal risk factors and/or causative mechanisms for the medullary infarction after successful endovascular trapping of the VADA are sorely needed, to minimize such a complication. PMID:22639714

  6. EXPERIMENTAL MODELLING OF AORTIC ANEURYSMS

    PubMed Central

    Doyle, Barry J; Corbett, Timothy J; Cloonan, Aidan J; O’Donnell, Michael R; Walsh, Michael T; Vorp, David A; McGloughlin, Timothy M

    2009-01-01

    A range of silicone rubbers were created based on existing commercially available materials. These silicones were designed to be visually different from one another and have distinct material properties, in particular, ultimate tensile strengths and tear strengths. In total, eleven silicone rubbers were manufactured, with the materials designed to have a range of increasing tensile strengths from approximately 2-4MPa, and increasing tear strengths from approximately 0.45-0.7N/mm. The variations in silicones were detected using a standard colour analysis technique. Calibration curves were then created relating colour intensity to individual material properties. All eleven materials were characterised and a 1st order Ogden strain energy function applied. Material coefficients were determined and examined for effectiveness. Six idealised abdominal aortic aneurysm models were also created using the two base materials of the study, with a further model created using a new mixing technique to create a rubber model with randomly assigned material properties. These models were then examined using videoextensometry and compared to numerical results. Colour analysis revealed a statistically significant linear relationship (p<0.0009) with both tensile strength and tear strength, allowing material strength to be determined using a non-destructive experimental technique. The effectiveness of this technique was assessed by comparing predicted material properties to experimentally measured methods, with good agreement in the results. Videoextensometry and numerical modelling revealed minor percentage differences, with all results achieving significance (p<0.0009). This study has successfully designed and developed a range of silicone rubbers that have unique colour intensities and material strengths. Strengths can be readily determined using a non-destructive analysis technique with proven effectiveness. These silicones may further aid towards an improved understanding of the

  7. Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture.

    PubMed

    Fox, Benjamin; Humphries, William Edward; Doss, Vinodh T; Hoit, Daniel; Elijovich, Lucas; Arthur, Adam S

    2014-01-01

    A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture. PMID:25355741

  8. Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture.

    PubMed

    Fox, Benjamin; Humphries, William Edward; Doss, Vinodh T; Hoit, Daniel; Elijovich, Lucas; Arthur, Adam S

    2015-11-01

    A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture. PMID:25361560

  9. [Giant intracranial aneurysm in three years old boy: case report].

    PubMed

    de Tella, Osvaldo Inácio; Crosera, João Francisco; Herculano, Marco Antonio; de Paiva Neto, Manoel Antonio

    2006-06-01

    Cerebral aneurysms are rare in the pediatric age group and differ from adults' aneurysms in size, localization and incidence. We report a 3-year-old boy with giant middle cerebral artery aneurysms who presented with subarachnoid hemorrhage. The patient was submitted to surgical treatment and the postoperative period was uneventful.

  10. Early and late results of resection of abdominal aortic aneurysms.

    PubMed Central

    Scobie, K.; McPhail, N.; Hubbard, C.

    1977-01-01

    Resection of the abdominal aortic aneurysm is being performed with decreasing operative mortality and morbidity. Among 190 patients undergoing this procedure at the Ottawa Civic Hospital between 1970 and 1975, 53 (28%) had a ruptured aneurysm and 137 (72%), a nonruptured aneurysm. Mean age of the patients was 66.2 years. Concomitant disease was frequent, 73% of patients having two or more associated diseases; the average number of associated diseases per patient was 2.25. Operative mortality in the group with ruptured aneurysms was 51%, and in the group with nonruptured aneurysms, 4%. Postoperative morbidity was 85% among those with a ruptured aneurysm, 67% among those with imminent rupture before operation and 34% among the others with a nonruptured aneurysm. Graft complications occurred in 15% of those with a ruptured aneurysm and 9% of those with a nonruptured aneurysm. Among survivors of the operation 73% and 81% of those with a ruptured and a nonruptured aneurysm, respectively, are known to be alive. In both groups causes of late death included infection or thrombosis of the graft and mesenteric thrombosis, as well as causes unrelated to the operation. Surgical management of the abdominal aortic aneurysm is advocated in all but patients at poor risk for operation who have asymptomatic aneurysms less than 6 cm in diameter. PMID:872011

  11. Massive superior mesenteric venous aneurysm with portal venous thrombosis.

    PubMed

    Starikov, Anna; Bartolotta, Roger J

    2015-01-01

    Portal venous aneurysm is a rare and sometimes dangerous vascular pathology, which can result in thrombosis or rupture. We present the computed tomography, magnetic resonance, and sonographic imaging of a 27-year-old man with superior mesenteric venous aneurysm and subsequent thrombosis following acute pancreatitis. This multimodality imaging approach can prove useful in the evaluation of these rare aneurysms.

  12. The Management of Intracranial Aneurysms During Pregnancy: A Systematic Review.

    PubMed

    Barbarite, Eric; Hussain, Shahrose; Dellarole, Anna; Elhammady, Mohamed Samy; Peterson, Eric

    2016-01-01

    Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is safe and effective. Furthermore, we suggest that coil embolization be considered a first line treatment over clipping for surgical management of the pregnant population. Going forward, we encourage the establishment of formal guidelines for managing intracranial aneurysms during pregnancy. PMID:27400091

  13. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  14. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  15. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  16. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  17. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  18. Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire

    PubMed Central

    Park, Jung Soo; Lee, Jong Myong

    2016-01-01

    Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms.

  19. Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire.

    PubMed

    Park, Jung Soo; Kwak, Hyo Sung; Lee, Jong Myong

    2016-09-01

    Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms.

  20. Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire

    PubMed Central

    Park, Jung Soo; Lee, Jong Myong

    2016-01-01

    Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms. PMID:27651873

  1. Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire.

    PubMed

    Park, Jung Soo; Kwak, Hyo Sung; Lee, Jong Myong

    2016-09-01

    Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms. PMID:27651873

  2. [Surgical techniques for thoracic and thoracoabdominal aneurysm repair].

    PubMed

    Imoto, K; Uchida, K

    2010-07-01

    We introduce our technique for the treatment of aneurysms arising in the descending thoracic aorta and the thoracoabdominal aorta. Thoracotomy is performed at a single site. The costal arch is transected to ensure an adequate field of vision. A lifting hook is used to open the proximal side of the aorta. The diaphragm is not totally transected to preserve respiratory function after surgery. In principle, partial extracorporeal circulation is performed using a percutaneous cardiopulmonary support system. The dose of heparin for systemic treatment is limited to 50 U/kg. The abdominal branches are perfused with the use of balloon catheters. Cardiac arrest is induced for about 10 seconds by intravenous administration of adenosine triphosphate to avoid aortic injury when the proximal aorta is clamped during partial extracorporeal circulation and to prevent massive bleeding when the elephant trunk is clamped. To prevent paraplegia, the Adamkiewics artery and 2 pairs of adjacent intercostal arteries identified by preoperative computed tomography are reconstructed, and cerebrospinal drainage and motor evoked potential monitoring are performed.

  3. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: Correlation of aneurysm neck size and treatment results

    SciTech Connect

    Zubillaga, A.F.; Guglielmi, G.; Vinuela, F.; Duckwiler, G.R.

    1994-05-01

    To devise a method to measure aneurysm neck size on angiographic films, and to correlate the sizes obtained with the extent of endovascular aneurysm occlusion, performed with electrically detachable coils. The angiograms of 79 intracranial aneurysms treated by endovascular occlusion using electrically detachable coils were retrospectively analyzed. A method using the average reported caliber of the major intracranial vessels was applied to determine the aneurysm neck sizes on the diagnostic angiograms. The cases were divided into two groups according to neck size, 4 mm being the discriminative value for small and wide necks. The posttreatment angiogram of each case was analyzed to evaluate the degree of occlusion achieved by the technique. Necks were successfully measured in 95% of the aneurysms. Complete aneurysm thrombosis was observed in 85% of the small-necked aneurysms and in 15% of the wide-necked aneurysms. Accurate angiographic measurements of neck diameter can be obtained in most aneurysms. The size of an aneurysm neck correlates well with the results of the endovascular treatment. Small-necked aneurysms can be satisfactorily occluded with this technique. In wide-necked aneurysms this technique should be reserved for lesions having a high surgical risk. 10 refs., 1 fig., 1 tab.

  4. Aneurysm

    MedlinePlus

    ... of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ... Diseases of the aorta. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ...

  5. The Asymmetric Vascular Stent: Efficacy in a rabbit aneurysm model

    PubMed Central

    Ionita, Ciprian N; Paciorek, Ann M; Dohatcu, Andreea; Hoffmann, Kenneth R; Bednarek, Daniel R; Kolega, John; Levy, Elad I; Hopkins, L. Nelson; Rudin, Stephen; Mocco, J.

    2009-01-01

    Background and Purpose Development of hemodynamic modifying devices to treat intracranial aneurysms (IAs) is an active area of research. The asymmetric vascular stent (AVS), a stent containing a low porosity patch, is such device. We evaluate AVS efficacy in an in vivo IA model. Methods We created twenty-four elastase rabbit model aneurysms: thirteen treated with the AVS, five treated with standard coronary stents, and six untreated controls. Four weeks following treatment, aneurysms underwent follow-up angiography, cone-beam micro-CT, histologic evaluation, and selective electron microscopy scanning. Results Four rabbits died early in the study: three during AVS treatment and one control (secondary to intra-procedural vessel injury and an unrelated tumor, respectively). AVS-treated aneurysms exhibited very weak or no aneurysm flow immediately after treatment and no flow in all aneurysms at follow-up. Stent-treated aneurysms showed flow both after treatment (5/5) and at follow-up (3/5). All control aneurysms remained patent during the study. Micro-CT scans showed: 9/9 of scanned AVS aneurysms were occluded, (6/9) AVSs were ideally placed and (3/9) the low porosity region partially covered the aneurysm neck; stent-treated aneurysms were 1/5 occluded, 2/5 patent, and 2/5 partially-patent. Histology results demonstrated: for AVS-treated aneurysms, advanced thrombus organization in the (9/9); for stent-treated aneurysms (1/4) no thrombus, (2/4) partially-thrombosed and (1/4) fully-thrombosed; for control aneurysms (4/4) no thrombus. Conclusion The use of AVSs shows promise as a viable new therapeutic in intracranial aneurysm treatment. These data encourage further investigation and provide substantial support to the AVS concept. PMID:19131663

  6. Ultrasound Screening for Abdominal Aortic Aneurysm

    PubMed Central

    2006-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness of ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA). Clinical Need Abdominal aortic aneurysm is a localized abnormal dilatation of the aorta greater than 3 cm. In community surveys, the prevalence of AAA is reported to be between 2% and 5.4%. Abdominal aortic aneurysms are found in 4% to 8% of older men and in 0.5% to 1.5% of women aged 65 years and older. Abdominal aortic aneurysms are largely asymptomatic. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture of the AAA. Often rupture may occur without warning, causing acute pain. Rupture is always life threatening and requires emergency surgical repair of the ruptured aorta. The risk of death from ruptured AAA is 80% to 90%. Over one-half of all deaths attributed to a ruptured aneurysm take place before the patient reaches hospital. In comparison, the rate of death in people undergoing elective surgery is 5% to 7%; however, symptoms of AAA rarely occur before rupture. Given that ultrasound can reliably visualize the aorta in 99% of the population, and its sensitivity and specificity for diagnosing AAA approaches 100%, screening for aneurysms is worth considering as it may reduce the incidence of ruptured aneurysms and hence reduce unnecessary deaths caused by AAA-attributable mortality. Review Strategy The Medical Advisory Secretariat used its standard search strategy to retrieve international health technology assessments and English-language journal articles from selected databases to determine the effectiveness of ultrasound screening for abdominal aortic aneurysms. Case reports, letters, editorials, nonsystematic reviews, non-human studies, and comments were excluded. Questions asked: Is population-based AAA screening effective in improving health outcomes in asymptomatic populations? Is AAA screening acceptable to the population? Does this affect the

  7. Abdominal aneurysm and horseshoe kidney: a review.

    PubMed Central

    Bietz, D S; Merendino, K A

    1975-01-01

    Two patients with aortic abdominal aneurysms in association with horseshoe kidney are presented, making a total of 34 cases recorded in the literature. In 29 patients, the aneurysm was resected and five patients were non-resectable. Because of the abnormalities in vascular supply to the abnormal kidney, it is important to diagnose the combination of aneurysm and horseshoe kidney preoperatively. An error in diagnosis should be unusual if an intravenous pyelogram is routinely obtained on all patients. This study may reveal abnormalities which will allow the diagnosis of horseshoe kidney to be made or suspected. If the intravenous pyelogram is abnormal, it should be followed by an aortogram. This may substantiate the diagnosis of aneurysm and horseshoe kidney and provide the necessary detailed information regarding the pattern of blood supply and its relationship to functioning tissue. The amount and disposition of functioning renal parenchyma may be further amplified by renal scan. If this sequence is followed, the unanticipated combination of abdominal aneurysm and horseshoe kidney should be rare. PMID:1130850

  8. Radiological features of azygous vein aneurysm.

    PubMed

    Choudhary, Arabinda Kumar; Moore, Michael

    2014-04-01

    Mediastinal masses are most commonly associated with malignancy. Azygous vein aneurysm is a very rare differential diagnosis of mediastinal mass. We report here three cases of azygous vein aneurysm including children and adult patients. In the pediatric patient it was further complicated by thrombosis and secondary pulmonary embolism. We describe the radiological features on CXR, MRI, CT, PET-CT, US and angiogram and their differential diagnosis. Imaging findings of continuity with azygous vein, layering of contrast medium on enhanced CT and dynamic MRA showing filling of the mass at the same time as the azygous vein without prior enhancement will be strongly suggestive of azygous vein aneurysm with transtracheal ultrasound being the definitive test in these patients. It is important to keep a vascular origin mass in the differential diagnosis of mediastinal masses. Also, in young healthy patients with pulmonary embolism, a vascular etiology such as azygous vein aneurysm should be carefully evaluated. This article will help the clinicians to learn about the imaging features of azygous vein aneurysm on different imaging modalities.

  9. Aneurysm strength can decrease under calcification.

    PubMed

    Volokh, Konstantin Y; Aboudi, Jacob

    2016-04-01

    Aneurysms are abnormal dilatations of vessels in the vascular system that are prone to rupture. Prediction of the aneurysm rupture is a challenging and unsolved problem. Various factors can lead to the aneurysm rupture and, in the present study, we examine the effect of calcification on the aneurysm strength by using micromechanical modeling. The calcified tissue is considered as a composite material in which hard calcium particles are embedded in a hyperelastic soft matrix. Three experimentally calibrated constitutive models incorporating a failure description are used for the matrix representation. Two constitutive models describe the aneurysmal arterial wall and the third one - the intraluminal thrombus. The stiffness and strength of the calcified tissue are simulated in uniaxial tension under the varying amount of calcification, i.e. the relative volume of the hard inclusion within the periodic unit cell. In addition, the triaxiality of the stress state, which can be a trigger for the cavitation instability, is tracked. Results of the micromechanical simulation show an increase of the stiffness and a possible decrease of the strength of the calcified tissue as compared to the non-calcified one. The obtained results suggest that calcification (i.e. the presence of hard particles) can significantly affect the stiffness and strength of soft tissue. The development of refined experimental techniques that will allow for the accurate quantitative assessment of calcification is desirable. PMID:26717251

  10. Creep of posterior dental composites.

    PubMed

    Papadogianis, Y; Boyer, D B; Lakes, R S

    1985-01-01

    The creep of microspecimens of posterior dental composites was studied using a torsional creep apparatus. Shear stresses were maintained for 3 h and recovery was followed for 50 h. Creep curves were obtained at 21, 37, and 50 degrees C and four torque levels. The effect of conditioning the specimens in water up to 8 weeks was studied. The posterior composites exhibited linear viscoelastic behavior at low deformations. They had higher shear moduli and greater resistance to creep than conventional and microfilled composites. In aging experiments, maximum shear moduli occurred when specimens were 48 h to 1 week old. Subsequent softening was attributed to water absorption. Residual strain was highest when the composites were stressed within 24 h of initiating polymerization. Residual strain was very low in specimens 48 h to 8 weeks of age.

  11. Posterior cruciate ligament of the knee (image)

    MedlinePlus

    The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability.

  12. Current strategies for the management of aneurysmal subarachnoid hemorrhage.

    PubMed

    Solomon, R A; Fink, M E

    1987-07-01

    Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm represents a major health issue. Although most people who experience an aneurysmal SAH survive to be admitted to a hospital, less than one third of these patients ever return to their premorbid status. Clearly, morbidity of this magnitude demands reevaluation of the clinical approach to this problem. This article reviews the natural history of aneurysmal SAH, and examines the current therapeutic strategies that have been suggested to improve the outcome. Careful evaluation of the existing data suggests that early aneurysm surgery and aggressive postoperative volume expansion therapy constitute the best presently available approach to patients with ruptured intracranial aneurysms. PMID:3297009

  13. Radiological features of uncommon aneurysms of the cardiovascular system

    PubMed Central

    Kalisz, Kevin; Rajiah, Prabhakar

    2016-01-01

    Although aortic aneurysms are the most common type encountered clinically, they do not span the entire spectrum of possible aneurysms of the cardiovascular system. As cross sectional imaging techniques with cardiac computed tomography and cardiac magnetic resonance imaging continue to improve and becomes more commonplace, once rare cardiovascular aneurysms are being encountered at higher rates. In this review, a series of uncommon, yet clinically important, cardiovascular aneurysms will be presented with review of epidemiology, clinical presentation and complications, imaging features and relevant differential diagnoses, and aneurysm management. PMID:27247710

  14. Brain abscess after endosaccular embolisation of a cerebral aneurysm.

    PubMed

    Chen, Guangzhong; Zhan, Shengquan; Chen, Wei; Li, Zhaojie; Zhou, Dong; Zeng, Shaojian; Lin, Xiaofeng; Tang, Kai; Zhou, Dexiang; Shu, Hang

    2014-01-01

    Endovascular embolization has become an important treatment option for cerebral aneurysms, along with surgical clipping. But few literatures mentioned infectious complications after coiling of aneurysms. We present a patient with a brain abscess that developed after endosaccular embolization of a left middle cerebral artery aneurysm. The brain abscess was located adjacent to the aneurysm and discovered more than 2 months after embolization. We discuss the clinical implications of this rare complication and review the literature for infections related to the coils used for embolization of aneurysms.

  15. Osteosarcoma of the posterior maxilla

    PubMed Central

    Prabhusankar, K.; Karande, Amol; Jerry, Jeethu J.; Rishal, Yousef

    2016-01-01

    Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report. PMID:27652252

  16. Osteosarcoma of the posterior maxilla.

    PubMed

    Prabhusankar, K; Karande, Amol; Jerry, Jeethu J; Rishal, Yousef

    2016-08-01

    Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report. PMID:27652252

  17. Osteosarcoma of the posterior maxilla

    PubMed Central

    Prabhusankar, K.; Karande, Amol; Jerry, Jeethu J.; Rishal, Yousef

    2016-01-01

    Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report.

  18. Effect of dietary β carotene on cerebral aneurysm and subarachnoid haemorrhage in the brain apo E-/- mice.

    PubMed

    Gopal, K; Nagarajan, P; Raj, T Avinash; Jahan, P; Ganapathy, H S; Mahesh Kumar, M J

    2011-10-01

    Atherosclerosis will lead to stenosis/occlusion in the lumen of various arteries of living body. This can lead various conditions including myocardial infarction, cerebral infarction/aneurysm and peripheral artery disease. Ang II is believed to be an important regulatory peptide involved in maintaining cardiovascular homeostasis and pathogenesis of various cardiovascular diseases. Matrix metalloproteinase's (MMPs), adhesion molecules and plasminogen systems are involved in the inflammatory reaction of various blood vessels as well as pathogenesis of cerebro vasuclar disease in apo E(-/-) mice during angiotensin II injection. The present study analyses the role of ang II in development of cerebral aneurysm and also evaluated the mRNA levels of MMPs, adhesion molecules, plasminogen systems and peroxisome proliferators-associated receptors in the brain of apo E(-/-) mouse during the progression of cerebral aneurysm and ischemic conditions. Also, this study evaluates the role of dietary β carotene on cerebrovascular disease. Serum total cholesterol (TC), Low density lipoprotein (LDL) and triglyceride (TG) levels were significantly increased in angiotensin II treated animals and further β carotene supplementation reduces TC but does not affect the triglyceride and LDL levels. Circulating levels of macrophages were significantly increased in angiotensin treated animals and further beta carotene supplementation significantly reduced the circulating macrophages. Cerebro meningeous aneurysm, subarachnoid haemorrhage, multiple foci of infarction, necrosis and infiltration of inflammatory cells were observed in the cerebral hemispheres of ang II treated animals, however, infarction size were reduced and no aneurysm, inflammatory foci was observed in β carotene treated animals. Real time analysis showed down regulation of mRNA levels of MMP 2, uPA, PAI, PPAR-A, MCSF1 and up regulation of tPA and MCP-1 in the brain during the progression of cerebral aneurysm and β carotene

  19. Swine hybrid aneurysm model for endovascular surgery training.

    PubMed

    Namba, K; Mashio, K; Kawamura, Y; Higaki, A; Nemoto, S

    2013-06-01

    The aim of this study was to develop a technically simple swine aneurysm-training model by inserting a silicone aneurysm circuit in the cervical vessels. A silicone aneurysm circuit was created by designing multiple aneurysms in size and configuration on a silicone vessel. Five swine underwent surgical implantation of this circuit in the cervical vessels: one end in the common carotid artery and the other in the external jugular vein. Using this model, an aneurysm coiling procedure was simulated under fluoroscopic guidance, roadmapping and digital subtraction angiography. Creating an aneurysm model for training purposes by this method was technically simple and enabled the formation of a wide variety of aneurysms in a single procedure. The quality of the model was uniform and the model was reproducible. Coiling training using this model resembled a realistic clinical situation. The swine hybrid aneurysm-training model was advantageous from the standpoint of technical simplicity in the creation and variety of aneurysms it provided. The swine hybrid aneurysm model may be an additional option for aneurysm coiling training. PMID:23693037

  20. Swine Hybrid Aneurysm Model for Endovascular Surgery Training

    PubMed Central

    Namba, K.; Mashio, K.; Kawamura, Y.; Higaki, A.; Nemoto, S.

    2013-01-01

    Summary The aim of this study was to develop a technically simple swine aneurysm-training model by inserting a silicone aneurysm circuit in the cervical vessels. A silicone aneurysm circuit was created by designing multiple aneurysms in size and configuration on a silicone vessel. Five swine underwent surgical implantation of this circuit in the cervical vessels: one end in the common carotid artery and the other in the external jugular vein. Using this model, an aneurysm coiling procedure was simulated under fluoroscopic guidance, roadmapping and digital subtraction angiography. Creating an aneurysm model for training purposes by this method was technically simple and enabled the formation of a wide variety of aneurysms in a single procedure. The quality of the model was uniform and the model was reproducible. Coiling training using this model resembled a realistic clinical situation. The swine hybrid aneurysm-training model was advantageous from the standpoint of technical simplicity in the creation and variety of aneurysms it provided. The swine hybrid aneurysm model may be an additional option for aneurysm coiling training. PMID:23693037

  1. A Case of Glucocorticoid Remediable Aldosteronism and Thoracoabdominal Aneurysms

    PubMed Central

    Shahrrava, Anahita; Moinuddin, Sunnan; Boddu, Prajwal; Shah, Rohan

    2016-01-01

    Glucocorticoid remediable aldosteronism (GRA) is rare familial form of primary aldosteronism characterized by a normalization of hypertension with the administration of glucocorticoids. We present a case of GRA and thoracoabdominal aneurysm complicated by multiple aortic dissections requiring complex surgical and endovascular repairs. Registry studies have shown a high rate of intracranial aneurysms in GRA patients with high case fatality rates. The association of thoracoabdominal aneurysms with GRA has not been described, thus far, in literature. Studies have shown that high tissue aldosterone levels concomitant with salt intake have a significant role in the pathogenesis of aneurysms and this may explain the formation of aneurysms in the intracranial vasculature and aorta. The association of GRA with thoracic aortic aneurysms needs to be further studied to develop screening recommendations for early identification and optimal treatment. Also, the early use of mineralocorticoid antagonists may have a significant preventive and attenuating effect in aneurysm formation, an association which needs to be confirmed in future studies. PMID:27366333

  2. Endoport-Assisted Microsurgical Treatment of a Ruptured Periventricular Aneurysm

    PubMed Central

    Chen, Ching-Jen; Caruso, James; Buell, Thomas; Crowley, R. Webster; Liu, Kenneth C.

    2016-01-01

    Background and Importance. Ruptured periventricular aneurysms in patients with moyamoya disease represent challenging pathologies. The most common methods of treatment include endovascular embolization and microsurgical clipping. However, rare cases arise in which the location and anatomy of the aneurysm make these treatment modalities particularly challenging. Clinical Presentation. We report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle. Distal endovascular access was not possible, and embolization risked the sacrifice of arteries supplying critical brain parenchyma. Using the BrainPath endoport system, the aneurysm was able to be accessed. Since the fusiform architecture of the aneurysm prevented clip placement, the aneurysm was ligated with electrocautery. Conclusion. We demonstrate the feasibility of endoport-assisted approach for minimally invasive access and treatment of uncommon, distally located aneurysms. PMID:27195160

  3. Endoport-Assisted Microsurgical Treatment of a Ruptured Periventricular Aneurysm.

    PubMed

    Chen, Ching-Jen; Caruso, James; Starke, Robert M; Ding, Dale; Buell, Thomas; Crowley, R Webster; Liu, Kenneth C

    2016-01-01

    Background and Importance. Ruptured periventricular aneurysms in patients with moyamoya disease represent challenging pathologies. The most common methods of treatment include endovascular embolization and microsurgical clipping. However, rare cases arise in which the location and anatomy of the aneurysm make these treatment modalities particularly challenging. Clinical Presentation. We report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle. Distal endovascular access was not possible, and embolization risked the sacrifice of arteries supplying critical brain parenchyma. Using the BrainPath endoport system, the aneurysm was able to be accessed. Since the fusiform architecture of the aneurysm prevented clip placement, the aneurysm was ligated with electrocautery. Conclusion. We demonstrate the feasibility of endoport-assisted approach for minimally invasive access and treatment of uncommon, distally located aneurysms. PMID:27195160

  4. Uterine cirsoid aneurysm: MRI and MRA

    SciTech Connect

    Joja, Ikuo; Asakawa, Mari; Motoyama, Kazumi

    1996-03-01

    Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm. 28 refs., 7 figs

  5. Infected Aneurysm after Endoscopic Submucosal Dissection.

    PubMed

    Gen, Shiko; Usui, Ryuichi; Sasaki, Takaya; Nobe, Kanako; Takahashi, Aya; Okudaira, Keisuke; Ikeda, Naofumi

    2016-01-01

    A 79-year-old man on hemodialysis was hospitalized for further investigation. Early gastric cancer was diagnosed by gastrointestinal endoscopy and endoscopic submucosal dissection (ESD) was performed. Fever and abdominal pain thereafter developed, and a severe inflammatory response was observed on a blood test. Contrast computed tomography (CT) showed ulcer-like projections and soft tissue surrounding the aorta, from the celiac to left renal artery. An infected aneurysm was diagnosed. Although infected aneurysms developing after laparoscopic cholecystectomy or biopsy of contiguous esophageal duplication cyst have been reported, those developing after ESD have not. When fever and abdominal pain develop after ESD, an infected aneurysm should be considered and contrast CT performed. PMID:27181541

  6. Giant and thrombosed left ventricular aneurysm.

    PubMed

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  7. Endovascular Aneurysm Repair: Current and Future Status

    SciTech Connect

    Hinchliffe, R. J. Ivancev, K.

    2008-05-15

    Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.

  8. Renal interventions during endovascular aneurysm repair.

    PubMed

    Davies, Mark G

    2013-12-01

    Renal insufficiency is a risk factor for mortality and morbidity during endovascular aneurysm repair. Multiple changes in practice have occurred to mitigate renal injury and renal dysfunction. Transrenal fixation does carry an increased risk of a decline in renal function in the medium term. Renal stenting for athero-occlusive disease during endovascular aneurysm repair needs careful consideration, as indications have changed and there are unexpected consequences with early vessel occlusion. The growing number of renal interventions during complex endovascular aneurysm repair with the advent of chimney snorkel/periscope techniques and the introduction of fenestrated grafts has shown the resilience of the intervention with relatively low renal issues (approximately 10%), but has also illustrated the need for additional device development.

  9. Giant and thrombosed left ventricular aneurysm

    PubMed Central

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-01-01

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention. PMID:26225205

  10. Emergency endovascular treatment of popliteal aneurysms.

    PubMed

    Saratzis, Athanasios; Melas, Nikolaos; Dixon, Hannah; Saratzis, Nikolaos

    2010-12-01

    Popliteal artery aneurysm (PAA), despite being rare, is the most common peripheral aneurysm. It can present as acute thrombosis and occlusion of the aneurysmal segment, and distal embolization, causing either chronic or acute limb ischemia. It has traditionally been treated with open surgical reconstruction. Endovascular repair of PAAs has recently been applied electively with a favourable early and mid-term outcome; however there is a lack of reports on the endovascular treatment of PAAs presenting with acute complications. This report describes the treatment of a thrombosed PAA in a 58 year old male using an endovascular stent-graft and also provides a systematic review of the literature on the emergency endovascular treatment of PAAs.

  11. Embolomycotic Aneurysm of External Iliac Artery

    PubMed Central

    Terán, Nemesio A.; Gonzalez, Nerio M.; García, Luis; Gonzalez, Freddy E.; Rivera, Humberto E.

    1989-01-01

    We report a case of embolomycotic aneurysm of the right iliac artery secondary to bacterial endocarditis. The patient, a 33-year-old woman, presented with unilateral hydronephrosis and lower extremity edema caused by aneurysmal compression of the ipsilateral ureter and the external iliac vein. She was treated with ligation and an extraperitoneal left-external-iliac-artery to right-femoral-artery bypass using a knitted Dacron prosthesis. Since her surgery, our patient has been well except for persistence of moderate leg edema. To the best of our knowledge, we are reporting the 1st case of embolomycotic external-iliac-artery aneurysm secondary to bacterial endocarditis and resulting in hydronephrosis and venous insufficiency. (Texas Heart Institute Journal 1989;16:51-55) Images PMID:15227238

  12. Giant and thrombosed left ventricular aneurysm.

    PubMed

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention. PMID:26225205

  13. Factors Influencing the Management of Unruptured Intracranial Aneurysms.

    PubMed

    Gillani, Rebecca L; Podraza, Katherine M; Luthra, Nijee; Origitano, Thomas C; Schneck, Michael J

    2016-01-01

    Background Deciding how to manage an unruptured intracranial aneurysm can be difficult for patients and physicians due to controversies about management. The decision as to when and how to intervene may be variable depending on physicians' interpretation of available data regarding natural history and morbidity and mortality of interventions. Another significant factor in the decision process is the patients' conception of the risks of rupture and interventions and the psychological burden of harboring an unruptured intracranial aneurysm. Objective  To describe which factors are being considered when patients and their physicians decide how to manage unruptured intracranial aneurysms.  Materials & methods  In a retrospective chart review study, we identified patients seen for evaluation of an unruptured intracranial aneurysm. Data was collected regarding patient and aneurysm characteristics. The physician note pertaining to the management decision was reviewed for documented reasons for intervention. Results  Of 88 patients included, 36 (41%) decided to undergo open or endovascular surgery for at least one unruptured intracranial aneurysm. Multiple aneurysms were present in 14 (16%) patients. Younger patients and current smokers were more likely to undergo surgery, but gender and race did not affect management. Aneurysm size and location strongly influenced management. The most common documented reasons underlying the decision of whether to intervene were the risk of rupture, aneurysm size, and risks of the procedure. For 23 aneurysms (21%), there were no factors documented for the management decision.  Conclusion  The risk of rupture of unruptured intracranial aneurysms may be underestimated by currently available natural history data. Major factors weighed by physicians in management decisions include aneurysm size and location, the patient's age, and medical comorbidities along with the risk of procedural complications. Additional data is needed to define

  14. Age at intracranial aneurysm rupture among generations

    PubMed Central

    Woo, D; Hornung, R; Sauerbeck, L; Brown, R; Meissner, I; Huston, J; Foroud, T; Broderick, J

    2009-01-01

    Background: Previous studies have reported intracranial aneurysm (IA) occurring at young ages in subsequent generations. These studies did not correct for duration of follow-up. Second-generation members who would have their ruptured IA late in life may not be detected due to shorter follow-up time than the first generation. We examined families in which ruptured IA occurred in two consecutive generations for the hypothesis that the second generation (F1) was more likely to have a rupture at a younger age than the older generation (F0). Methods: The Familial Intracranial Aneurysm (FIA) Study is a multicenter, international study recruiting families of ruptured and unruptured IA. All available family members are interviewed. Cox proportional hazards regression models and Kaplan-Meier curves were used to examine differences by generation. Results: Although we found that the F1 generation was more likely to have an aneurysm rupture at a younger age than the F0 generation, we found that this was largely because of a lack of follow-up time in the F1 generation. The F1 generation had 50% the rupture rate of the prior generation. When analyzed by Kaplan-Meier curves, we found a tendency to have a slightly later rupture rate in the F1 generation once time to follow-up was included in the analysis model. Conclusions: Families of ruptured intracranial aneurysm (IA) do not appear to demonstrate “anticipation.” Our finding suggests that genetic epidemiology of ruptured IA should examine all types of variations such as single base-pair changes, deletions, insertions, and other variations that do not demonstrate anticipation. GLOSSARY FIA = familial intracranial aneurysm; IA = intracranial aneurysm; SAH = subarachnoid hemorrhage. PMID:19237697

  15. Superior mesenteric vein aneurysm: a case report.

    PubMed

    Truong, Tuan; Vu, Jonathan-Hien; Matteo, Jerry

    2012-01-01

    A 46-year-old female was found to have a saccular superior mesenteric vein (SMV) aneurysm on computed tomography (CT) scan during workup for abdominal pain. It measured 3.5 cm in diameter. The SMV aneurysm was successfully resected, and the SMV was repaired with femoral vein patch angioplasty. She was placed on coumadin for 3 months. At follow-up, the vein patch repair was patent and the patient was doing well with complete resolution of her abdominal pain. PMID:22156158

  16. [A case of retroperitoneal venous aneurysm].

    PubMed

    Maeda, S; Tamaki, M; Yamamoto, N; Takeda, A; Kuriyama, M; Kawada, Y; Mizoguchi, Y; Kasahara, M

    1991-01-01

    Venous aneurysm is a rare entity and the disease occurring in the retroperitoneal space has been reported in only 4 cases. Therefore, the fifth case of retroperitoneal venous aneurysm on the literature was described. A 59-year-old male was referred to our clinic because of painless large mass in the left abdomen. Computed tomography, ultrasonography, and magnetic resonance imaging revealed a cystic mass at the perinephric space. The resected cyst contained yellow-grayish fluid. The cyst wall was microscopically formed of 4 layers; blood and cholesterin, hyaline, muscle and collagen from the inner to outer side. He is well without any trouble after the operation.

  17. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    SciTech Connect

    Cil, Barbaros E. Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-04-15

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

  18. Combined Posterior and Anterior Ankle Arthroscopy

    PubMed Central

    Scholten, Peter E.; van Dijk, C. Niek

    2012-01-01

    Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities. PMID:23227391

  19. Investigation of new flow modifying endovascular image-guided interventional (EIGI) techniques in patient-specific aneurysm phantoms (PSAPs) using optical imaging

    NASA Astrophysics Data System (ADS)

    Sherman, J. R.; Rangwala, H. S.; Ionita, C. N.; Dohatcu, A. C.; Lee, J. W.; Bednarek, D. R.; Hoffmann, K. R.; Rudin, S.

    2008-03-01

    Effective minimally invasive treatment of cerebral bifurcation aneurysms is challenging due to the complex and remote vessel morphology. An evaluation of endovascular treatment in a phantom involving image-guided deployment of new asymmetric stents consisting of polyurethane patches placed to modify blood flow into the aneurysm is reported. The 3D lumen-geometry of a patient-specific basilar-artery bifurcation aneurysm was derived from a segmented computed-tomography dataset. This was used in a stereolithographic rapid-prototyping process to generate a mold which was then used to create any number of exact wax models. These models in turn were used in a lost-wax technique to create transparent elastomer patient-specific aneurysm phantoms (PSAP) for evaluating the effectiveness of asymmetric-stent deployment for flow modification. Flow was studied by recording real-time digitized video images of optical dye in the PSAP and its feeding vessel. For two asymmetric stent placements: through the basilar into the right-posterior communicating artery (RPCA) and through the basilar into the left-posterior communicating artery (LPCA), the greatest deviation of flow streamlines away from the aneurysm occurred for the RPCA stent deployment. Flow was also substantially affected by variations of inflow angle into the basilar artery, resulting in alternations in washout times as derived from time-density curves. Evaluation of flow in the PSAPs with real-time optical imaging can be used to determine new EIGI effectiveness and to validate computational-fluid-dynamic calculations for EIGI-treatment planning.

  20. Lower leg compartment syndrome in neurofibromatosis 1 patient with plexiform neurofibrom: a case report of aneurysm rupture.

    PubMed

    Nishida, Yoshihiro; Tsukushi, Satoshi; Urakawa, Hiroshi; Arai, Eisuke; Kozawa, Eiji; Ishiguro, Naoki

    2014-05-01

    A 37-year-old woman with neurofibromatosis type 1 was referred for a rapidly growing plexiform neurofibroma of the left lower leg, acute serious pain, and leg palsy because of concern for malignant transformation of the tumor. Contrast-enhanced computed tomography confirmed a rupture of anterior tibial artery aneurysm, resulting in both anterior and posterior compartment syndrome in her left leg. Arterial involvement in neurofibromatosis is a well known; however, rupture of peripheral arteries is exceptional. Moreover, coexistence with plexiform neurofibroma occasionally delays the diagnosis with suspicion of malignant transformation without awareness of a vascular rupture.

  1. Endovascular Aneurysm Sealing for the Treatment of Ruptured Abdominal Aortic Aneurysms

    PubMed Central

    Brownrigg, Jack R. W.; Karthikesalingam, Alan; Patterson, Benjamin O.; Holt, Peter J. E.; Hinchliffe, Robert J.; Morgan, Robert A.; Loftus, Ian M.; Thompson, Matthew M.

    2015-01-01

    Purpose: To assess the feasibility and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS), a novel therapeutic alternative whose feasibility has not been established in rAAAs due to the unknown effects of the rupture site on the ability to achieve sealing. Case Report: Between December 2013 and April 2014, 5 patients (median age 71 years, range 57–90; 3 men) with rAAAs were treated with the Nellix EVAS system at a single institution. Median aneurysm diameter was 70 mm (range 67–91). Aneurysm morphology in 4 of the 5 patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent-grafts; the remaining patient was outside the IFU for standard stent-grafts but treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range 0–3). Two patients died of multiorgan failure after re-laparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up 9.2 months). Conclusion: EVAS for the management of infrarenal rAAAs appears feasible. The use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology. PMID:25904491

  2. Clinical Analysis of Giant Intracranial Aneurysms with Endovascular Embolization

    PubMed Central

    Ha, Sang Woo

    2012-01-01

    Objective The purpose of this study was to perform a clinical analysis of nine patients with giant aneurysms managed with endovascular embolization. Methods From March 2000 to September 2009, nine cases of giant intracranial aneurysms were treated (five unruptured and four ruptured). The nine patients included two males and seven females who were 47 to 72 years old (mean, 59.2 years old). The types of giant intracranial aneurysms were eight internal carotid artery aneurysms and one vertebral artery aneurysm. Treatment for each aneurysm was chosen based on anatomic relationships, aneurysmal factors, and the patients' clinical state. Three patients underwent endovascular coiling with stent and six initially underwent endovascular coiling alone. Medical records, operation records, postoperative angiographies, and follow-up angiographies were reviewed retrospectively. Results Eight out of nine patients showed good clinical outcomes. (six were excellent and two were good) after a mean follow-up period of 27.9 months. Six (67%) of the nine patients had a near-complete occlusions on the post-operative angiogram (mean, 13.5 months after the procedure). Occlusion rates of 90% or higher were obtained for eight (89%) of all the patients. One patient died due to multiple organ failure. Stents were ultimately required at some point for managing four aneurysms. Two patients needed additional procedures because of aneurysm regrowth. Conclusion Endovascular treatment could be an alternative option for managing giant aneurysms adjuvant to surgical intervention. PMID:23210026

  3. Prediction of outcomes in young adults with aneurysmal subarachnoid hemorrhage.

    PubMed

    Chotai, Silky; Ahn, Sung-Yong; Moon, Hong-Joo; Kim, Jong-Hyun; Chung, Heung-Seob; Chung, Yong-Gu; Kwon, Taek-Hyun

    2013-01-01

    Subarachnoid hemorrhage (SAH) is rare in young adults and little is known about aneurysms in this subgroup. The effect of clinical and prognostic factors on the outcome based on the Glasgow Outcome Scale (GOS) scores and the predictors of unfavorable outcomes were analyzed in young adults with aneurysmal SAH. A retrospective review of the clinical parameters, including age, sex, hypertension, smoking status, hyperlipidemia, location of the cerebral aneurysm, size of the aneurysm, multiplicity, perioperative complication such as hydrocephalus, vasospasm, and hematoma, and Hunt and Hess and Fisher grading on presentation, was conducted in 108 young adults (mean age 34.8 years) managed at our institute. The outcome was classified based on GOS grading into unfavorable (GOS scores 1-3) or favorable (GOS scores 4 or 5). The overall mortality rate was 3.7% (4/108 patients). Univariate regression analysis for the outcomes at discharge found that age at the time of presentation, male sex, size of aneurysm, multiple aneurysms, hyperlipidemia, and poor Hunt and Hess and Fischer grades were associated with unfavorable outcome. Multivariate regression analysis found independent effects of sex, multiple aneurysms, size of aneurysm, and Hunt and Hess grade on the outcome at discharge. Size of aneurysm, presence of multiple aneurysms, Hunt and Hess grade, and hypertension were the predictors of outcome at mean 2-year follow up based on multivariate exact regression analysis. The multimodal approach with aggressive medical management, early intervention, and surgical treatment might contribute to favorable long-term outcomes in patients with poor expected outcomes.

  4. Molecular basis and genetic predisposition to intracranial aneurysm

    PubMed Central

    Weinsheimer, Shantel; Ronkainen, Antti; Kuivaniemi, Helena

    2014-01-01

    Intracranial aneurysms, also called cerebral aneurysms, are dilatations in the arteries that supply blood to the brain. Rupture of an intracranial aneurysm leads to a subarachnoid hemorrhage, which is fatal in about 50% of the cases. Intracranial aneurysms can be repaired surgically or endovascularly, or by combining these two treatment modalities. They are relatively common with an estimated prevalence of unruptured aneurysms of 2%–6% in the adult population, and are considered a complex disease with both genetic and environmental risk factors. Known risk factors include smoking, hypertension, increasing age, and positive family history for intracranial aneurysms. Identifying the molecular mechanisms underlying the pathogenesis of intracranial aneurysms is complex. Genome-wide approaches such as DNA linkage and genetic association studies, as well as microarray-based mRNA expression studies, provide unbiased approaches to identify genetic risk factors and dissecting the molecular pathobiology of intracranial aneurysms. The ultimate goal of these studies is to use the information in clinical practice to predict an individual's risk for developing an aneurysm or monitor its growth or rupture risk. Another important goal is to design new therapies based on the information on mechanisms of disease processes to prevent the development or halt the progression of intracranial aneurysms. PMID:25117779

  5. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    PubMed Central

    Choudhri, Omar; Mukerji, Nitin; Steinberg, Gary K.

    2013-01-01

    Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefited in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application of these two

  6. Longevity of Posterior Composite Restorations

    PubMed Central

    Opdam, N.J.M.; van de Sande, F.H.; Bronkhorst, E.; Cenci, M.S.; Bottenberg, P.; Pallesen, U.; Gaengler, P.; Lindberg, A.; Huysmans, M.C.D.N.J.M.; van Dijken, J.W.

    2014-01-01

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years’ follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. PMID:25048250

  7. Huge interparietal posterior fontanel meningohydroencephalocele

    PubMed Central

    Dos Santos, Manuel Filipe Dias; de Santa Barbara, Rita de Cassia

    2015-01-01

    Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion. PMID:26484324

  8. Genes and Abdominal Aortic Aneurysm

    PubMed Central

    Hinterseher, Irene; Tromp, Gerard; Kuivaniemi, Helena

    2010-01-01

    Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since first candidate gene studies were published 20 years ago, nearly 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. The studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, if appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called CNTN3 which is located on chromosome 3p12.3. Two follow-up studies, however, could not replicate the association. Two other SNPs, which are located on chromosome 9p21 and 9q33 were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense RNA that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute to AAA pathogenesis. PMID:21146954

  9. Pleural Empyema and Aortic Aneurysm

    PubMed Central

    Wu, Ching-Yang; Su, Ta-Wei; Huang, Kuo-Yang; Ko, Po-Jen; Yu, Sheng-Yueh; Kao, Tsung-Chi; Shen, Te-Chun; Chou, Tzu-Yi; Lin, Cheng-Li; Kao, Chia-Hung

    2015-01-01

    Abstract Pleural empyema (PE) may evolve into necrosis, fistula in the thorax, and sepsis; thus, it is also associated with high mortality. We investigated and analyzed the risk of aortic aneurysm (AA) in a cohort study of patients with PE. A total of 34,250 patients diagnosed with PE were identified as the PE cohort, and 137,000 patients without PE were selected randomly as the control group and matched by sex, age, and index year of PE diagnosis. Patients ages 20 years and younger with a history of AA were excluded. The risk of AA was analyzed using a Cox proportional hazards regression model. Excess risk of AA development was 1.69-fold higher in PE patients (adjusted hazard ratio [aHR] = 1.69; 95% confidence interval [CI] = 1.39–2.05) compared with non-PE patients. The patients with PE exhibited a greater adjusted risk of AA (aHR = 2.01; CI = 1.44–2.81) even if they did not have any of the 9 comorbidities included in our analysis (diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, heart failure, cardiac artery disease, stroke, bacterial endocarditis, and rheumatic endocarditis). Compared with the patients without any of the 9 comorbidities or PE, the patients with only PE had a greater risk of developing AA (aHR = 2.00; CI = 1.43–2.79). The PE cohort had a significantly higher cumulative incidence of AA than the non-PE cohort did during 12 years of follow-up. In a large-scale cohort, patients with PE are linked with an increased risk of AA. PMID:26632741

  10. Mechanical properties of the aneurysmal aorta.

    PubMed

    MacSweeney, S T; Young, G; Greenhalgh, R M; Powell, J T

    1992-12-01

    The mechanical properties of the abdominal aorta were investigated non-invasively in 30 patients with aortic aneurysm and 11 with peripheral arterial disease. The distensibility of the aorta was measured using M-mode ultrasonography, permitting non-invasive assessment of the pressure--strain elastic modulus or aortic stiffness, Ep. The median Ep value increased from 4.0 N/cm2 in control subjects in their third decade of life (n = 10) to 10.4 N/cm2 in middle age (n = 11) to 14.0 N/cm2 in the elderly (n = 13). In the presence of a normal diameter, peripheral arterial disease with aortic atherosclerosis had little effect on aortic stiffness, median Ep being 16.0 N/cm2. Aneurysmal dilatation was associated with a significant increase in aortic stiffness, median Ep being 31.3 N/cm2 (P < 0.001). For aortas of normal diameter, Ep was at all ages dependent on mean arterial pressure. In patients with aortic aneurysms there was no clear relationship between Ep and mean arterial pressure or aortic diameter. Of the patients studied, 15 underwent aortic reconstruction; increasing aortic stiffness (log Ep) was associated with a decreased medial elastin content of the aortic biopsy (r = -0.63, P < 0.02). This study demonstrates the marked stiffness or inelasticity of dilated or aneurysmal vessels, part of which is attributable to the loss of elastin.

  11. Endovascular repair of abdominal aortic aneurysms.

    PubMed

    Arnaoutakis, Dean J; Zammert, Martin; Karthikesalingam, Alan; Belkin, Michael

    2016-09-01

    Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality. Nonetheless, most abdominal aortic aneurysms are now repaired using endovascular stent grafts. The technology is not perfect as several postoperative complications, namely endoleak, stent-graft migration, and graft limb thrombosis, can develop and therefore lifelong imaging surveillance is required. In addition, a postoperative inflammatory response has been documented after endovascular repair of aortic aneurysms; the clinical significance of this finding has yet to be determined. Subsequently, the safety and applicability of endovascular stent grafts are likely to improve and expand with the introduction of newer-generation devices and with the simplification of fenestrated systems. PMID:27650343

  12. Portal vein aneurysm: What to know.

    PubMed

    Laurenzi, Andrea; Ettorre, Giuseppe Maria; Lionetti, Raffaella; Meniconi, Roberto Luca; Colasanti, Marco; Vennarecci, Giovanni

    2015-11-01

    Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956 and since then less than 200 cases have been reported. The aim of this article is to provide an overview of the international literature to better clarify various aspects of this rare nosological entity and provide clear evidence-based summary, when available, of the clinical and surgical management. A systematic literature search of the Pubmed database was performed for all articles related to portal vein aneurysm. All articles published from 1956 to 2014 were examined for a total of 96 reports, including 190 patients. Portal vein aneurysm is defined as a portal vein diameter exceeding 1.9 cm in cirrhotic patients and 1.5 cm in normal livers. It can be congenital or acquired and portal hypertension represents the main cause of the acquired version. Surgical indication is considered in case of rupture, thrombosis or symptomatic aneurysms. Aneurysmectomy and aneurysmorrhaphy are considered in patients with normal liver, while shunt procedures or liver transplantation are the treatment of choice in case of portal hypertension. Being such a rare vascular entity its management should be reserved to high-volume tertiary hepato-biliary centres. PMID:26188840

  13. Aneurysmal bone cyst of the fifth metacarpal.

    PubMed

    Ozyurek, Selahattin; Rodop, Osman; Kose, Ozkan; Cilli, Feridun; Mahirogullari, Mahir

    2009-08-01

    Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that even more rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. A 21-year-old man presented with a history of pain and local swelling over his fifth metacarpal of 5 months' duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En-block resection of the tumor and autologous bicortical strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for 3 weeks after the patient received 3 weeks of physiotherapy. Kirschner wires were removed 6 weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after 3 years of follow-up with en-block resection and reconstruction with iliac crest graft. Radiographic examination demonstrated the osseous integration of the graft with no signs of recurrence. Although treatment should be planned individually according to lesion site and size and to patient age, we suggest en-block resection to prevent recurrence and secondary surgical interventions particularly in cases with no articular involvement.

  14. Endovascular treatment of coarctation and related aneurysms.

    PubMed

    Galiñanes, E L; Krajcer, Z

    2014-06-11

    Today,surgical repair has almost doubled the 30year survival rate in patients with coarctation of the aorta (CoA), and 72% to 98% of patients now reach adulthood. Possible late complications include malignant hypertension, left ventricular dysfunction, aortic valve dysfunction, recurrent CoA, and aneurysm formation with risk of rupture. Treating postoperative CoA-related aneurysms with observation alone is associated with a mortality rate of 36%, compared with 9% for surgical repair. Even in the best surgeons' hands, aortic surgery has associated complications, and the complexity of reoperative surgery makes the risks substantially greater. For patients with CoA-related aneurysm, endovascular treatment constitutes a good alternative to reoperative surgery because it poses a lower risk of morbidity and mortality. Implanting an endograft has been shown to be successful in treating CoA and related aneurysms, producing excellent intermediate outcomes and minimal morbidity and mortality. Despite evidence that using covered stents improves outcomes, the superiority of any particular stent type has yet to be established. With a variety of endografts available, the decision of which stent to use depends on anatomy, availability, and operator preference.

  15. The Endovascular Management of Iliac Artery Aneurysms

    SciTech Connect

    Stroumpouli, Evangelia; Nassef, Ahmed; Loosemore, Tom; Thompson, Matt; Morgan, Robert; Belli, Anna-Maria

    2007-11-15

    Background: Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. Purpose: The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm.Results:The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks.Conclusion:We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates.

  16. Pulsatile blood flow in Abdominal Aortic Aneurysms

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  17. Endovascular treatment of abdominal aortic aneurysms

    PubMed Central

    Buck, Dominique B.; van Herwaarden, Joost A.; Schermerhorn, Marc L.; Moll, Frans L.

    2014-01-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  18. [A case of retroperitoneal venous aneurysm].

    PubMed

    Tsujimura, A; Nishimura, K; Matsumiya, K; Oka, T; Takaha, M; Arima, R; Kurata, A

    1992-09-01

    A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.

  19. Bilateral nonfistulous congenital coronary arterial aneurysms.

    PubMed

    Wilson, C S; Weaver, W F; Zeman, E D; Forker, A D

    1975-02-01

    A 15 year old boy collapsed and died after participating in a basketball game. Autopsy revealed bilateral congenital coronary arterial aneurysms. The diagnosis was made post mortem but, retrospectively, might have been suspected during life, even before angiography. The clues to the correct diagnosis were chest pain, a systolic and diastolic murmur and a mass on the right heart border in the chest roentgenogram.

  20. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Dredla, Brynn

    2015-01-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient’s medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis. PMID:27053985

  1. Effect of radioactivity on stent-graft incorporation after endovascular treatment of aneurysms: An animal study.

    PubMed

    Lerouge, Sophie; Raymond, Jean; Schloesser, Klaus; Gaboury, Louis; Soulez, Gilles

    2006-12-01

    Poor stent-graft (SG) incorporation into the vessel wall, following endovascular repair of abdominal aortic aneurysms (EVAR), can lead to endoleaks and SG migration. Low-dose radiation can prevent aneurysm recurrence after coil embolization, and has been associated with a "paradoxical" increase in neointima formation after stenting in a few studies. It was hypothesized that in situ beta radiation emitted from SG could improve its incorporation by preventing the persistence of circulating channels between the implant and the vessel wall and increasing neointima formation around the SG. Phosphorus 32 ((32)P, 200 or 400 kBq per SG (n = 6 each)) was ion implanted on the external surface of balloon-expandable SGs. Twelve radioactive and six non-radioactive SGs were deployed in iliac arteries of nine Mongrel dogs. Neointima formation inside the graft and the persistence of circulating flow through an artificial groove created during the endovascular procedure were assessed by follow-up imaging and by blinded, computerized histomorphometric analysis after animal sacrifice at 3 months. Occlusion occurred in four radioactive SGs. A lesser number of patent grooves was observed along high-activity SGs than along control SGs (1/3 versus 4/4). No difference in neointima formation was observed in radioactive and non-radioactive SGs. Alteration of external graft surface was observed after ion implantation. Ion implantation of (32)P on SGs does not seem to be a viable strategy to improve incorporation and prevent type-I endoleak after EVAR.

  2. Endovascular Treatment of ACom Intracranial Aneurysms

    PubMed Central

    Finitsis, S.; Anxionnat, R.; Lebedinsky, A.; Albuquerque, P.C.; Clayton, M.F.; Picard, L.; Bracard, S.

    2010-01-01

    Summary The immediate and long-term outcomes, complications, recurrences and the need for retreatment were analyzed in a series of 280 consecutive patients with anterior communicating artery aneurysms treated with the endovascular technique. From October 1992 to October 2001 280 patients with 282 anterior communicating artery aneurysms were addressed to our center. For the analysis, the population was divided into two major groups: group 1, comprising 239 (85%) patients with ruptured aneurysms and group 2 comprising of 42 (15%) patients with unruptured aneurysms. In group 1, 185 (77.4%) patients had a good initial pre-treatment Hunt and Hess grade of I-III. Aneurysm size was divided into three categories according to the larger diameter: less than 4 mm, between 4 and 10 mm and larger than 10 mm. The sizes of aneurysms in groups 1 and 2 were identical but a less favorable neck to depth ratio of 0.5 was more frequent in group 2. Endovascular treatment was finally performed in 234 patients in group 1 and 34 patients in group 2. Complete obliteration was more frequently obtained in group 2 unlike a residual neck or opacification of the sac that were more frequently seen in group 1. No peri-treatment complications were recorded in group 2. In group 1 the peri-treatment mortality and overall peri-treatment morbidity were 5.1% and 8.1% respectively. Eight patients (3.4%) in group 1 presented early post treatment rebleeding with a mortality of 88%. The mean time to follow-up was 3.09 years. In group 1, 51 (21.7%) recurrences occurred of which 14 were minor and 37 major. In group 2, eight (23.5%) recurrences occurred, five minor and three major. Two patients (0.8%) presented late rebleeding in group 1. Twenty-seven second endovascular retreatments were performed, 24 (10.2%) in group 1 and three (8.8%) in group 2, seven third endovascular retreatments and two surgical clippings in group 1 only. There was no additional morbidity related to retreatments. Endovascular treatment

  3. Volumetric analysis of abdominal aortic aneurysm

    NASA Astrophysics Data System (ADS)

    Baskin, Kevin M.; Kusnick, Catherine A.; Shamsolkottabi, Susanne; Lang, Elvira V.; Corson, J. D.; Stanford, William; Thompson, Brad H.; Hoffman, Eric A.

    1996-04-01

    The purpose of this study was to develop a valid, reliable and accurate system of measurement of abdominal aortic aneurysms, using volumetric analysis of x-ray computed tomographic data. This study evaluates illustrative cases, and compares measurements of AAA phantoms, using standard 2D versus volumetric methods. To validate the volumetric analysis, four phantom aneurysms were constructed in a range of diameters (4.5 - 7.0 cm) which presents the greatest management challenge to the clinician. These phantoms were imaged using a Toshiba Xpress SX helical CT. Separate scans were obtained at conventional (10 mm X 10 mm) and thin slice (5 mm X 5 mm) collimations. The thin slices were reconstructed at 2 mm intervals. Data from each of the 96 scans were interpreted using a standard 2D approach, then analyzed using task-oriented volumetric software. We evaluate patient assessments, and compare greatest outer diameters of phantoms, by standard versus volumetric methods. Qualitative differences between solutions based on standard versus volumetric analysis of illustrative patient cases are substantial. Expert radiologists' standard measurements of phantom aneurysms are highly reliable (r2 equals 0.901 - 0.958; p < 0.001), but biased toward significant overestimation of aneurysm diameters in the range of clinical interest. For the same phantoms, volumetric analysis was both more reliable (r2 equals 0.986 - 0.996; p < 0.001), and more accurate, with no significant bias in the range of interest. Volumetric analysis promotes selection of more valid management strategies, by providing vital information not otherwise available, and allowing more reliable and accurate assessment of abdominal aortic aneurysms. It is particularly valuable in the presence of aortic tortuosity, vessel eccentricity, and uncertain involvement of critical vessels.

  4. Circulating glioma biomarkers

    PubMed Central

    Kros, Johan M.; Mustafa, Dana M.; Dekker, Lennard J.M.; Sillevis Smitt, Peter A.E.; Luider, Theo M.; Zheng, Ping-Pin

    2015-01-01

    Validated biomarkers for patients suffering from gliomas are urgently needed for standardizing measurements of the effects of treatment in daily clinical practice and trials. Circulating body fluids offer easily accessible sources for such markers. This review highlights various categories of tumor-associated circulating biomarkers identified in blood and cerebrospinal fluid of glioma patients, including circulating tumor cells, exosomes, nucleic acids, proteins, and oncometabolites. The validation and potential clinical utility of these biomarkers is briefly discussed. Although many candidate circulating protein biomarkers were reported, none of these have reached the required validation to be introduced for clinical practice. Recent developments in tracing circulating tumor cells and their derivatives as exosomes and circulating nuclear acids may become more successful in providing useful biomarkers. It is to be expected that current technical developments will contribute to the finding and validation of circulating biomarkers. PMID:25253418

  5. Flow dynamics in a lethal anterior communicating artery aneurysm.

    PubMed

    Kerber, C W; Imbesi, S G; Knox, K

    1999-01-01

    We describe and analyze the flow dynamics in replicas of a human anterior communicating artery aneurysm. The replicas were placed in a circuit of pulsating non-Newtonian fluid, and flows were adjusted to replicate human physiologic parameters. Individual slipstreams were opacified with isobaric dyes, and images were recorded on film and by CT/MR angiography. When flow in the afferent (internal carotid) and efferent (anterior and middle cerebral) arteries was bilaterally equal, slipstreams rarely entered the aneurysm. When flow in either the afferent or efferent vessels was not symmetrical, however, slipstreams entered the aneurysm neck, impinged upon the aneurysm dome, and swirled within the aneurysm. Unequal flow in carotid or cerebral systems may be necessary to direct pathologic, fluid slipstreams into an aneurysm. PMID:10588134

  6. Assessment of coronary artery aneurysms with multiplane transesophageal echocardiography.

    PubMed

    Kosar, E; Chandraratna, P A

    1997-05-01

    Coronary artery aneurysms are rare and may be difficult to detect clinically. Multiplane transesophageal echocardiography provides numerous imaging planes that may improve the assessment of coronary aneurysms and act as an adjunct to standard angiography. Five patients with angiographically detected coronary aneurysms were studied with multiplane transesophageal echocardiography and Doppler flow imaging. Transesophageal echocardiography was successful in identifying the size and characteristics of the coronary aneurysms. Doppler ultrasound identified markedly increased flow velocity in a patient with a coronary arteriovenous fistula and decreased coronary flow velocity in two patients with aneurysmal coronary arteries and intracoronary thrombus. Multiplane transesophageal echocardiography is a useful, noninvasive method of assessing coronary artery aneurysms and may act as an adjunct to angiography in identifying fistula anastomosis.

  7. Design and biocompatibility of endovascular aneurysm filling devices

    PubMed Central

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; Landsman, Todd L.; Boyle, Anthony; Wierzbicki, Mark A.; Hasan, Sayyeda M.; Follmer, Douglas; Bryant, Jesse; Small, Ward; Maitland, Duncan J.

    2014-01-01

    The rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. We also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing. PMID:25044644

  8. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    NASA Astrophysics Data System (ADS)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  9. Dissecting aneurysm of the anterior temporal artery: case report.

    PubMed

    Umeoka, Katsuya; Shirokane, Kazutaka; Mizunari, Takayuki; Kobayashi, Shiro; Teramoto, Akira

    2011-01-01

    A 65-year-old woman presented a rare dissecting aneurysm of the anterior temporal artery (ATA) manifesting as headache. Computed tomography and magnetic resonance imaging revealed a mixed-density mass in the horizontal segment of the middle cerebral artery. Emergent angiography demonstrated aneurysmal dilatation and a thrombosed mass in the sylvian fissure. Infectious aneurysm was excluded. She underwent emergent surgery to reduce the risk of repeated infarction and hemorrhage. The distal side of the ATA manifested occlusive changes suggestive of arterial dissection. The proximal side of the ATA was ligated and the lesion was excised. Histological examination confirmed that the aneurysmal dilatation was attributable to arterial dissection due to disruption of the internal elastic lamina. Distal dissecting aneurysms may occur in the absence of infectious disease. We recommend that ruptured distal dissecting aneurysms be treated surgically in the acute stage immediately after detection.

  10. Endoscopic management of posterior epistaxis: a review.

    PubMed

    McClurg, S W; Carrau, R

    2014-02-01

    The paradigm for the management of epistaxis, specifically posterior epistaxis, has undergone significant changes in the recent past. Recent prospective and retrospective data has shown that the endonasal surgical management of posterior epistaxis is superior to posterior nasal packing and angiography/embolization with regards to various factors including pain, cost-effectiveness, risk and overall control of bleeding. Endonasal endoscopic surgical techniques for posterior epistaxis include direct cauterization and transnasal endoscopic sphenopalatine/ posterior nasal artery ligation or cauterization with or without control of the anterior ethmoidal artery. Despite the evidence provided by the current literature, a universal treatment protocol has not yet been established. This review article provides an up-to-date assessment of the available literature, and presents a structured paradigm for the management of posterior epistaxis.

  11. Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery.

    PubMed

    Wang, Chun-Xi; Han, Li-Na; Liang, Fa-Qi; Chu, Fu-Tao; Jia, Xin

    2015-06-01

    The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

  12. Unilateral cerebellar and brain stem hypoplasia in a child with a postnatal diagnosis of dissecting aneurysm in basilar artery.

    PubMed

    Akkas-Yazici, Sinem; Benbir, Gulcin; Kocer, Naci; Yalcinkaya, Cengiz

    2014-12-01

    Cerebellum is highly vulnerable in the prenatal period. Increasing experience with fetal imaging studies has demonstrated that unilateral cerebellar hypoplasia (UCH) is mainly prenatally acquired, representing disruption rather than a true malformation. Here, we report the case of a 17-month-old boy presented with a sudden onset of abnormal eye movements, who was diagnosed during routine fetal screening with UCH and brain stem hypoplasia and suffered from cerebral palsy; however, no posterior arterial system pathology was detected on cranial magnetic resonance images at that time. Following this acute event, diagnostic neuroradiological interventions revealed a dissecting aneurysm with a saccular component in midbasilar arterial segment and hypoplastic left posterior cerebral artery, which may support the ischemic disruptive mechanism in the development of prenatally detected UCH in this child. The pathogenetic mechanisms for cerebellar disruption are certainly multifactorial in origin, although ischemic arterial etiologies were often undervalued.

  13. Placement technique for direct posterior composite restorations.

    PubMed

    Javaheri, D S

    2001-04-01

    Due to improved materials, instrumentation, and placement techniques, composite resins have overcome the traditional complications associated with wear resistance, microleakage, sensitivity, and tight anatomical contacts. Composite resins have been utilized with increased frequency for direct posterior restorations capable of satisfying the growing aesthetic expectations of contemporary dental patients. When properly placed, posterior composites can provide successful and predictable restorations. This article presents clinical considerations for the aesthetic conservation of posterior restorations with composite resin materials.

  14. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

    SciTech Connect

    Baldi, Sebastian Rostagno, Roman D.; Zander, Tobias; Llorens, Rafael; Schonholz, Claudio; Maynar, Manuel

    2008-03-15

    Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

  15. Coil embolization of ruptured frontopolar artery aneurysm: case report.

    PubMed

    Castaño-Leon, Ana M; Cicuendez, Marta; Paredes, Igor; Alen, Jose F; Navia, Pedro; Lagares, Alfonso

    2014-01-01

    Distal anterior cerebral artery aneurysms are infrequent. The most common location is at the bifurcation of the pericallosal and callosomarginal arteries. Cerebral artery anomalies can sometimes, at least partially, explain aneurysm formation in less common locations in relation to hemodynamic stress caused on the vascular wall. We report a very rare case of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm as a part of an anomalous anterior cerebral artery complex that was, for the first time, treated with endovascular coiling.

  16. A Case of Giant Right Atrial Aneurysm in a Child.

    PubMed

    Pawar, Ravindra S; Tiwari, Ashish; Suresh, P V; Raj, Vimal; Kaushik, Pradeepkumar

    2016-07-01

    Giant right atrial aneurysm is a rare entity in infants and children. It needs to be distinguished from an atrial diverticulum, which can have similar presentation. Generally, an incidental finding in children, it can present with varied symptoms. We report a case of a giant right atrial aneurysm in an asymptomatic child with a large clot in the dilated right atrium, who underwent successful resection of the atrial aneurysm. PMID:26884450

  17. Incidental Superior Hypophygeal Artery Aneurysm Embedded within Pituitary Adenoma

    PubMed Central

    Choi, Hong-Seok; Kim, Min-Su; Jung, Young-Jin

    2013-01-01

    Intra-cranial aneurysm can be incidental findings in patients with pituitary adenomas, and are usually located outside the pituitary region. However, the coexistence of intrasellar (not intracranial) aneurysms with pituitary adenomas is extremely rare. We report a patient with an incidental superior hypophygeal aneurysm embedded within a non-functional pituitary adenoma which was treated by transsphenoidal surgery after endovascular coil embolization. PMID:24278658

  18. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

    2000-01-01

    Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

  19. Recurrent Giant Cell Tumor of Skull Combined with Multiple Aneurysms

    PubMed Central

    Kim, Dae Hwan

    2016-01-01

    Giant cell tumors are benign but locally invasive and frequently recur. Giant cell tumors of the skull are extremely rare. A patient underwent a surgery to remove a tumor, but the tumor recurred. Additionally, the patient developed multiple aneurysms. The patient underwent total tumor resection and trapping for the aneurysms, followed by radiotherapy. We report this rare case and suggest some possibilities for treating tumor growth combined with aneurysm development. PMID:27195256

  20. Solid variant of aneurysmal bone cyst of the thoracic spine: a case report

    PubMed Central

    2011-01-01

    Introduction The solid variant of aneurysmal bone cyst is rare, and only 13 cases involving the spine have been reported to date, including seven in the thoracic vertebrae. The diagnosis is difficult to secure radiographically before biopsy or surgery. Case report An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits. An MRI scan demonstrated a 6 cm diameter enhancing multi-cystic mass centered at the T6 vertebral body with involvement of the left proximal sixth rib and extension into the pleural cavity; the spinal cord was severely compressed with evidence of abnormal T2 signal changes. Our patient was taken to the operating room for a total spondylectomy of T6 with resection of the left sixth rib from a single-stage posterior-only approach. The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation. Histologically, the resected specimen showed predominant solid fibroblastic proliferation, with minor foci of reactive osteoid formation, an area of osteoclastic-like giant cells, and cyst-like areas filled with erythrocytes and focal hemorrhage, consistent with a predominantly solid variant of aneurysmal bone cyst. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain. Conclusions Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting. The solid variant of aneurysmal bone cyst is difficult to diagnose radiologically before biopsy or surgery, and we hope to remind other physicians that it should be included in the differential diagnosis of any lytic expansile destructive lesion of the spine. PMID:21718507

  1. [Debranch Thoracic Endovascular Aortic Therapy for Extending Aneurysms].

    PubMed

    Miyamoto, Shinji

    2016-07-01

    To apply endovascular aortic repair for arch or thoracoabdominal pathology, it is essential to reconstruct the branches originating in the treatment area. In cases that a stentgraft has to reach ascending aorta we perform "in situ fenestration with squid capture technique".During the procedure cerebral circulation is maintained by percutaneous cardiopulmonary bypass. After deploying the stentgraft we stab it by a needle while squeezed by snare wire and stick a covered stentgraft eventually. Unlike chimney technique which also can be applied for zone 0 thoracic endovascular aortic therapy( TEVAR),this method has no risk of gutter leak. For now there are no fenestrated nor branched grafts in Japan so that we should perform hybrid TEVAR for throacoabdominal aneurysms if patients' conditions cannot allow graft replacement. In such a case we make bypasses between the common iliac artery( or left leg of bifurcated graft) and visceral arteries using a quadrated graft. All anastomosis can be done in a retroperitoneal single plane. TEVAR shouldn't be performed simultaneously with bypass because unstable hemodynamic increase risk of paraplegia. We have never experienced paraplegia among 50 cases except for 1 case in which TEVAR had to be done urgently under critical hypotension. PMID:27440024

  2. Novel repair of an external iliac vein aneurysm.

    PubMed

    Jayaraj, Arjun; Meissner, Mark

    2012-08-01

    Aneurysms involving the venous system are a rare entity. We report the case of a 37-year-old woman who presented to us with activity-limiting left gluteal pain and who on consequent workup was found to have a left external iliac vein aneurysm in a setting of iliocavomegaly. She underwent successful treatment of her aneurysm with a novel approach that involved staple plication and resection of the aneurysm over a balloon mandrel. We discuss the presentation, diagnosis, and surgical technique adopted for the treatment of this uncommon condition. PMID:22704912

  3. Abdominal aortic aneurysms: how can we improve their treatment?

    PubMed Central

    Scobie, T K

    1980-01-01

    Arteriosclerotic abdominal aortic aneurysms are present in a least 2% of the elderly population of the Western world and their number is increasing. Without treatment 30% of patients with asymptomatic aneurysms live for 5 years, although the risk of rupture becomes greater as the size of the aneurysm increases. Of those with untreated symptomatic aneurysms 80% are dead within a year. Elective repair of aneurysms has a low mortality, and 50% of the patients live for at least 5 years. Symptomatic aneurysms all cause pain and may produce other symptoms from pressure on adjacent structures, distal embolism, acute thrombosis or rupture. In 88% of cases an aneurysm can be diagnosed by physical examination alone; confirmatory tests include soft-tissue roentgenography of the abdomen, ultrasonography, computer-assisted tomography and aortography. Repair is indicated for symptomatic or ruptured aortic aneurysms and for asymptomatic aneurysms over 5 cm in diameter. Early diagnosis and referral for repair is essential for optimum treatment of this common condition. PMID:7004617

  4. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery

    PubMed Central

    Stendel, R.; Pietila, T.; Al, H; Schilling, A.; Brock, M.

    2000-01-01

    OBJECTIVES—Outcome of surgical treatment of cerebral aneurysms may be severely compromised by local cerebral ischaemia or infarction resulting from the inadvertent occlusion of an adjacent vessel by the aneurysm clip, or by incomplete aneurysm closure. It is therefore mandatory to optimise clip placement in situ to reduce the complication rate. The present study was performed to investigate the reliability of intraoperative microvascular Doppler ultrasonography (MDU) in cerebral aneurysm surgery, and to assess the impact of this method on the surgical procedure itself.
METHODS—Seventy five patients (19 men, 56 women, mean age 54.8 years, range 22-84 years) with 90 saccular cerebral aneurysms were evaluated. Blood flow velocities in the aneurysmal sac and in the adjacent vessels were determined by MDU before and after aneurysm clipping. The findings of MDU were analysed and compared with those of visual inspection of the surgical site and of postoperative angiography. Analysis was also made of the cases in which the clip was repositioned due to MDU findings.
RESULTS—A relevant stenosis of an adjacent vessel induced by clip positioning that had escaped detection by visual inspection was identified by Doppler ultrasonography in 17 out of 90 (18.9%) aneurysms. In addition, Doppler ultrasound demonstrated a primarily unoccluded aneurysm in 11 out of 90 (12.2%) patients. The aneurysm clip was repositioned on the basis of the MDU findings in 26 out of 90 (28.8%) cases. In middle cerebral artery (MCA) aneurysms, the MDU results were relevant to the surgical procedure in 17out of 44 (38.6%) cases. Whereas with aneurysms of the anterior cerebral artery significant findings occurred in only five of 32cases (15.6%; p<0.05). The clip was repositioned on the basis of the MDU results in 18 out of 50 (36%) aneurysms in patients with subarachnoid haemorrhage (SAH) grade I-V compared with only eight out of 40 (20%) aneurysms in patients without SAH (p<0.05).

  5. Dissecting thoracic aortic aneurysm associated with tuberculous pleural effusion

    PubMed Central

    Im, Kyong Shil; Choi, Min Kyung; Jeon, Yong Kyoung

    2016-01-01

    We present the case of thoracic aortic aneurysm associated with the tuberculous pleural effusion. An 82-year-old woman underwent emergency stent graft under a diagnosis of dissecting thoracic aortic aneurysm. Preoperative computed tomography revealed right pleural effusion supposed to the hemothorax caused by the dissecting aneurysm. But, the effusion was sanguineous color fluid and it was determined to result from pulmonary tuberculosis. The medical team was exposed to the pulmonary tuberculosis; fortunately no one became infected. Physicians should be aware of the possibility of an infected aortic aneurysm and prepare for pathogen transmission. PMID:27499987

  6. Infantile intracranial aneurysm of the superior cerebellar artery.

    PubMed

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-01-01

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. PMID:26929222

  7. Ruptured Gastric Aneurysm in α-1 Antitrypsin Deficiency.

    PubMed

    Jaruvongvanich, Veeravich; Spanuchart, Ittikorn; Scott Gallacher, T

    2016-07-01

    We present a unique vascular complication of α-1 antitrypsin deficiency (AATD) in a patient with an acute onset of epigastric pain and hemodynamic instability. Abdominal computed tomography angiography detected hemoperitoneum and hematoma within the gastrohepatic ligament with active extravasation. Abdominal angiography revealed left gastric aneurysms. An association between AATD and vascular aneurysms has been suggested to be secondary to unopposed proteolytic activity against arterial structural proteins. The aneurysm formation in aortic, superior mesenteric, inferior mesenteric, and splenic arteries has been reported. We report the first case with ruptured gastric artery aneurysm as a complication of AATD. PMID:27622197

  8. Stent Application for the Treatment of Cerebral Aneurysms

    PubMed Central

    Kim, Dong Joon; Kim, Dong Ik

    2011-01-01

    Rapid and striking development in both the techniques and devices make it possible to treat most of cerebral aneurysms endovascularly. Stent has become one of the most important tools in treating difficult aneurysms not feasible for simple coiling. The physical features, the dimensions, and the functional characteristics of the stents show considerable differences. There are also several strategies and tips to treat difficult aneurysms by using stent and coiling. Nevertheless, they require much experience in clinical practice as well as knowledge of the stents to treat cerebral aneurysms safely and effectively. In this report, a brief review of properties of the currently available stents and strategies of their application is presented. PMID:22125751

  9. Thrombosis modeling in intracranial aneurysms: a lattice Boltzmann numerical algorithm

    NASA Astrophysics Data System (ADS)

    Ouared, R.; Chopard, B.; Stahl, B.; Rüfenacht, D. A.; Yilmaz, H.; Courbebaisse, G.

    2008-07-01

    The lattice Boltzmann numerical method is applied to model blood flow (plasma and platelets) and clotting in intracranial aneurysms at a mesoscopic level. The dynamics of blood clotting (thrombosis) is governed by mechanical variations of shear stress near wall that influence platelets-wall interactions. Thrombosis starts and grows below a shear rate threshold, and stops above it. Within this assumption, it is possible to account qualitatively well for partial, full or no occlusion of the aneurysm, and to explain why spontaneous thrombosis is more likely to occur in giant aneurysms than in small or medium sized aneurysms.

  10. Intracranial Aneurysms: Wall Motion Analysis for Prediction of Rupture.

    PubMed

    Vanrossomme, A E; Eker, O F; Thiran, J-P; Courbebaisse, G P; Zouaoui Boudjeltia, K

    2015-10-01

    Intracranial aneurysms are a common pathologic condition with a potential severe complication: rupture. Effective treatment options exist, neurosurgical clipping and endovascular techniques, but guidelines for treatment are unclear and focus mainly on patient age, aneurysm size, and localization. New criteria to define the risk of rupture are needed to refine these guidelines. One potential candidate is aneurysm wall motion, known to be associated with rupture but difficult to detect and quantify. We review what is known about the association between aneurysm wall motion and rupture, which structural changes may explain wall motion patterns, and available imaging techniques able to analyze wall motion. PMID:25929878

  11. External jugular vein aneurysm: a source of thrombotic complications.

    PubMed

    Ioannou, C V; Kostas, T; Tsetis, D; Georgakarakos, E; Gionis, M; Katsamouris, A N

    2010-06-01

    Superficial venous aneurysms are rare and usually are uneventful. We present a case in which a 40-year old female presenting with a thrombosed external jugular vein aneurysm which previously caused an undetected pulmonary embolism. The aneurysm was excised and the external jugular vein was ligated under local anesthesia and anticoagulation was initiated. In conclusion aneurysms of the superficial venous system should be considered as a possible source of pulmonary emboli. These sites can safely be excised and ligated under local anesthesia offering long term protection from its possible complications. PMID:20502418

  12. Infantile intracranial aneurysm of the superior cerebellar artery.

    PubMed

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-02-29

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes.

  13. Matrix Metalloproteinases and Descending Aortic Aneurysms: Parity, Disparity, and Switch

    PubMed Central

    Theruvath, Tom P.; Jones, Jeffrey A.; Ikonomidis, John S.

    2015-01-01

    Central to the pathologic changes in developing aortic aneurysms are alterations in the abundance and activity of proteases, of which the most important for aneurysm production comprise the matrix metalloproteinase (MMP) family. In this review, literature demonstrating the role of MMPs in the development of aortic aneurysms is presented, with emphasis on the parity and disparity between the thoracic and abdominal aorta. Furthermore, the role of embryologic cellular origins and evidence of phenotypic switch will be addressed in terms of how this process alters MMP production during aneurysm development. PMID:21958052

  14. Progressive intracranial fusiform aneurysms and T-cell immunodeficiency.

    PubMed

    Piantino, Juan A; Goldenberg, Fernando D; Pytel, Peter; Wagner-Weiner, Linda; Ansari, Sameer A

    2013-02-01

    In the pediatric population, intracranial fusiform aneurysms have been associated with human immunodeficiency virus/acquired immunodeficiency syndrome and rarely with opportunistic infections related to other immunodeficiencies. The HIV virus and other infectious organisms have been implicated in the pathophysiology of these aneurysms. We present a child with T-cell immunodeficiency but no evidence of human immunodeficiency virus or opportunistic intracranial infections that developed progressive bilateral fusiform intracranial aneurysms. Our findings suggest a role of immunodeficiency or inflammation in the formation of some intracranial aneurysms.

  15. Polyarteritis with symptomatic intracerebral aneurysms at initial presentation.

    PubMed

    Munn, E J; Alloway, J A; Diffin, D C; Arroyo, R A

    1998-10-01

    Polyarteritis rarely involves the cerebral vasculature, and has not been reported to have an initial presentation with intracerebral aneurysms. We describe the first case of polyarteritis presenting with symptomatic intracerebral aneurysms. A literature review from 1966 to 1997 identified 5 additional cases with evidence of intracerebral aneurysms and polyarteritis. The cases reviewed all had evidence of longstanding systemic symptoms suggestive of polyarteritis prior to diagnosis. Polyarteritis with intracerebral aneurysms is associated with significant morbidity and mortality, and therefore must be recognized and treated early.

  16. Outcome After Surgical Treatment of Paraclinoid Carotid Aneurysms.

    PubMed

    Pasqualin, Alberto; Meneghelli, Pietro; Cozzi, Francesco; Chioffi, Franco

    2016-01-01

    Surgery on paraclinoid carotid aneurysms is technically demanding and entails considerable risks, especially to visual function. The aim of this study was to evaluate the clinical and visual outcome after surgery in 66 patients with paraclinoid carotid aneurysms (30 ruptured and 36 unruptured) treated between 1990 and 2014. Thirty-six aneurysms were of standard size, and 30 were large (16-20 mm) or giant (>20 mm); the Barami classification was used in every case. During surgery, multiple clips were needed in 25 % of patients with standard, and in 80 % of patients with large-giant aneurysms; temporary carotid occlusion was performed on 11 % of patients with standard and 63 % with large-giant aneurysms. Postoperatively, a cerebrospinal fluid fistula was repaired surgically in two patients. At the 3-month follow-up, the modified Rankin Score (mRS) was favorable (0-2) in 63 % of patients with ruptured and in 97 % with unruptured aneurysms; four patients presenting with large hematomas died. Postoperative visual impairment (worsening or newly developing deficit) was noted in 25 % of cases with standard and 14 % of cases with large-giant ruptured aneurysms, and, respectively, in 10 % with standard and 31 % with large-giant unruptured aneurysms. It has been concluded that surgery remains a reasonable choice in the management of patients with paraclinoid carotid aneurysms. PMID:27637626

  17. Ruptured Gastric Aneurysm in α-1 Antitrypsin Deficiency

    PubMed Central

    Spanuchart, Ittikorn; Scott Gallacher, T.

    2016-01-01

    We present a unique vascular complication of α-1 antitrypsin deficiency (AATD) in a patient with an acute onset of epigastric pain and hemodynamic instability. Abdominal computed tomography angiography detected hemoperitoneum and hematoma within the gastrohepatic ligament with active extravasation. Abdominal angiography revealed left gastric aneurysms. An association between AATD and vascular aneurysms has been suggested to be secondary to unopposed proteolytic activity against arterial structural proteins. The aneurysm formation in aortic, superior mesenteric, inferior mesenteric, and splenic arteries has been reported. We report the first case with ruptured gastric artery aneurysm as a complication of AATD. PMID:27622197

  18. Aneurysm of the pulmonary vein: an unusual cause of stroke.

    PubMed

    Emmert, Alexander; Jebran, Ahmad Fawad; Schmidt, Karsten; Hinterthaner, Marc; Bohnenberger, Hanibal; Bähr, Mathias; Schöndube, Friedrich A; Danner, Bernhard C

    2014-11-01

    This clinical report deals with a giant true pulmonary venous aneurysm, which was partially thrombosed. The overall incidence of pulmonary venous aneurysms is unknown, and they are reported only occasionally. We present the case of a previously healthy man with acute onset of ischemic cerebral stroke. The cause was a thrombus in a huge aneurysm of the left superior pulmonary vein. The patient subsequently underwent uncomplicated therapy for stroke, including thrombolysis followed by excision of the giant pulmonary venous aneurysm. As curative therapy we recommend complete resection of this rare entity.

  19. [Giant aneurysm of the inter-atrial septum].

    PubMed

    Akoudad, H; Cherti, M; Chaouki, S; Ztot, S; Haddour, L; el Mrabet, I; el Khadiri, A; Benmimoun, E G; Arharbi, A

    1999-01-01

    We report the case of a large atrial septal aneurysm and a review of the literature. Atrial septal aneurysm is found in 1-8% of normal subjects. Its prevalence is higher among patients with ischemic stroke. Transesophageal echocardiography is an optimal tool for the diagnosis of atrial septal aneurysm. The clinical course may be complicated by arterial embolism, but mechanical complications may also occur, as in this case. Due to the lack of general agreement, treatment options should be discussed on an individual basis for patients with atrial septal aneurysm. PMID:10093663

  20. The establishment of endovascular aneurysm coiling at a neurovascular unit: report of experience during early years.

    PubMed

    Norbäck, O; Gál, G; Johansson, M; Solander, S; Tovi, M; Persson, L; Ronne-Engström, E; Enblad, P

    2005-02-01

    The treatment of cerebral aneurysms is changing from surgical clipping to endovascular coiling (EVC) in many neurovascular centres. The aim of this study was to evaluate the technical results and clinical outcome at 6 months in a consecutive series of subarachnoid hemorrhage (SAH) patients treated with EVC, in a situation when the EVC had been established very rapidly as the first line of treatment at a neurovascular centre. The patient material comprised 239 SAH patients (155 women and 84 men, mean age 55 years, age range 16-81) allocated to EVC as the first line of treatment in the acute stage (within 3 weeks of rupture) between September 1996 and December 2000. Clinical grade on admission was Hunt & Hess (H&H) I and II in 42%, H&H III in 25% and H&H grade IV and V in 33% of the patients. The aneurysm was located in the anterior circulation in 82% of the cases. EVC was performed on days 0-3 in 77% of the cases. EVC of the target aneurysm was able to be completed in 222 patients (93%). Complete occlusion was achieved in 126 patients (53%). Procedural complications occurred in 39 patients (16%). Favourable clinical outcome was observed in 57%, severe disability in 28% and poor outcome in 14% of the patients. Favourable outcome was achieved in 77% of H&H I and II patients and in 43% of H&H III-V patients. The multivariate logistic regression analysis revealed that younger age, good neurological grade on admission, absence of intracerebral hematoma and intraventricular hematoma respectively, ICA-PcomA aneurysm location, later treatment and absence of complications were significant predictors of favourable outcome. After interventional training and installation of the X-ray system, the introduction and establishment of EVC at a neurovascular unit can be done in a short period of time and with favourable results. Future studies must concentrate on identifying factors of importance for the choice of interventional or surgical therapy. The results of this study indicate

  1. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    SciTech Connect

    Koike, Yuya Nishimura, Jun-ichi Hase, Soichiro Yamasaki, Motoshige

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  2. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment.

    PubMed

    Chen, Jia-Xiang; Lai, Ling-Feng; Zheng, Kuang; Li, Guo-Xiong; He, Xu-Ying; Li, Liang-Ping; Duan, Chuan-Zhi

    2015-09-01

    The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely. PMID:26100332

  3. Granulomatous encephalitis, intracranial arteritis, and mycotic aneurysm due to a free-living ameba.

    PubMed

    Martínez, A J; Sotelo-Avila, C; Alcalá, H; Willaert, E

    1980-01-01

    Primary amebic meningoencephalitis and granulomatous amebic encephalitis are well recognized clinicopathological entities caused by free-living amebas. Associated arteritis and "mycotic aneurysms" with infiltration of intracranial arteries by lymphocytes, amebic trophozoites and cysts have not been previously reported. A 26-month-old girl had a 3-week history of encephalitis, characterized, initially, by vomiting and low-grade fever. Subsequently, she developed ataxia, generalized weakness, lethargy, and esotropia. The first CSF showed 490 RBC/microliters, 705 WBC/microliters with 90% mononuclears. Her pupils reacted briskly to light. Moderate nuchal rigidity, nystagmus, fixed downward gaze, anisocoria, bilateral 6th nerve palsy, left arm monoparesis and left Babinski were present. CAT scan revealed slight symmetrical dilatation of anterior horns of lateral ventricles and an area of abnormal enhancement above the 3rd ventricle. She died 14 days after admission, 5 weeks after onset of symptoms. The brain showed focal necrotizing encephalopathy, involving thalami, cerebellum, brain stem, and cervical and upper thoracic spinal cord. Numerous free-living amebic trophozoites and cysts were present within a chronic granulomatous encephalitis. There were trombosis of basilar, posterior cerebral, and vertebral arteries with profuse chronic panarteritis, fibrinoid necrosis, and mycotic aneurysms. PMID:6892586

  4. [Peroperative risks in cerebral aneurysm surgery].

    PubMed

    Mustaki, J P; Bissonnette, B; Archer, D; Boulard, G; Ravussin, P

    1996-01-01

    The perioperative complications associated with cerebral aneurysm surgery require a specific anaesthetic management. Four major perioperative accidents are discussed in this review. The anaesthetic and surgical management in case of rebleeding subsequent to the re-rupture of the aneurysm is mainly prophylactic. It includes haemodynamic stability assurance, maintenance of mean arterial pressure (MAP) between 80-90 mmHg during stimulation of the patient such as endotracheal intubation, application of the skull-pin head-holder, incision, and craniotomy. The aneurysmal transmural pressure should be adequately maintained by avoiding an aggressive decrease of intracranial pressure. Once the skull is open, the brain must be kept slack in order to decrease pressure under the retractors and avoid the risks of stretching and tearing of the adjacent vessels. If, despite these precautions, the aneurysm ruptures again. MAP should be decreased to 60 mmHg and the brain rendered more slack, in order to allow direct clipping of the aneurysm, or temporary clipping of the adjacent vessels. The optimal agents in this situation are isoflurane (which decreases CMRO2), intravenous anaesthetic agents (inspite their negative inotropic effect, they may potentially protect the brain) and sodium nitroprusside. Vasospasm occurs usually between the 3rd and the 7th day after subarachnoid haemorrhage. It may be seen peroperatively. The optimal treatment, as well as prophylaxis, is moderate controlled hypertension (MAP > 100 mmHg), associated with hypervolaemia and haemodilution, the so-called triple H therapy, with strict control of the filling pressures. Other beneficial therapies are calcium antagonists (nimodipine and nicardipine), the removal of the blood accumulated around the brain and in the cisternae, and possibly local administration of papaverine. Abrupt MAP increases are controlled in order to maintain adequate aneurysmal transmural pressure. Beta-blockers, local anaesthetics

  5. Late iliac artery aneurysms and occlusive disease after aortic tube grafts for abdominal aortic aneurysm repair. A 35-year experience.

    PubMed Central

    Calcagno, D; Hallett, J W; Ballard, D J; Naessens, J M; Cherry, K J; Gloviczki, P; Pairolero, P C

    1991-01-01

    Controversy continues over whether patients treated with straight Dacron aortic tube grafts for an abdominal aortic aneurysm remain at significant risk for subsequent development of iliac aneurysm or occlusive disease. To address this issue, the authors performed a population-based analysis of 432 patients who had an abdominal aortic aneurysm diagnosed between 1951 and 1984. Aneurysm repair was performed eventually in 206 patients (48%). To ascertain differences in late development of graft-related complications, iliac aneurysms, and arterial occlusions, the authors compared all tube-graft patients with similar numbers of bifurcated-graft patients matched for age and year of operation. In the tube-graft group, no subsequent clinically evident or autopsy-proven iliac aneurysms or iliac occlusive disease were noted. Over a mean follow-up of 6 years (range, 4 to 18 years), new aortic aneurysms occurred in the proximal aorta in both tube and bifurcated-graft patients (5.0% and 2.5%, respectively). In contrast the cumulative incidence of graft-related complications was higher with a bifurcated prosthesis (12.8%) compared with a straight graft (5.0%) (p = 0.15). These problems generally occurred 5 to 15 years postoperatively and emphasize the need for long-term graft surveillance. The authors conclude that straight tube-grafts for repair of abdominal aortic aneurysms provide excellent late patency with minimal risk of subsequent iliac aneurysm development. PMID:1835832

  6. Fenestrated endovascular repair of abdominal aortic aneurysms: a less invasive option for the treatment of juxtarenal aortic aneurysms.

    PubMed

    Ehlert, Bryan A; Abularrage, Christopher J

    2016-05-01

    Endovascular aortic aneurysm repair has become the predominant surgical therapy for abdominal aortic aneurysms. Whereas anatomical limitations had become the major contraindication to endovascular treatment, fenestrated stent grafts were developed to overcome such obstacles. Fenestrated endovascular aortic aneurysm repair now provides an additional treatment option for patients felt to be unsuitable for an invasive open repair whose anatomy is not compatible with more traditional stent grafts. We review the evolution of fenestrated endovascular aortic aneurysm repair and compare its safety and efficacy to other endovascular options.

  7. Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

    PubMed

    Elabdi, Monsef; Roukhsi, Redouane; Tijani, Youssef; Chtata, Hassan; Jaafar, Abdeloihab

    2016-01-01

    Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty. PMID:26972754

  8. Apparatus Circulates Sterilizing Gas

    NASA Technical Reports Server (NTRS)

    Cross, John H.; Schwarz, Ray P.

    1991-01-01

    Apparatus circulates sterilizing gas containing ethylene oxide and chlorofluorocarbon through laboratory or medical equipment. Confines sterilizing gas, circulating it only through parts to be treated. Consists of two units. One delivers ethylene oxide/chlorofluorocarbon gas mixture and removes gas after treatment. Other warms, humidifies, and circulates gas through equipment to be treated. Process provides reliable sterilization with negligible residual toxicity from ethylene oxide. Particularly suitable for sterilization of interiors of bioreactors, heart/lung machines, dialyzers, or other equipment including complicated tubing.

  9. Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

    SciTech Connect

    Zanchetta, Mario Rigatelli, Gianluca; Pedon, Luigi; Zennaro, Marco; Ronsivalle, Salvatore; Maiolino, Pietro

    2003-09-15

    To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 {+-} 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy.

  10. Consistently inconsistent, the posterior vaginal wall.

    PubMed

    Hale, Douglass S; Fenner, Dee

    2016-03-01

    Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse.

  11. Postoperative rehabilitation of the posterior cruciate ligament.

    PubMed

    Edson, Craig J; Fanelli, Gregory C; Beck, John D

    2010-12-01

    Diagnosis and management of posterior cruciate ligament injuries has evolved, and now the treatment often includes surgical intervention. The purpose of this paper is to define the current approach to postsurgical management after the posterior cruciate ligament reconstruction, review conservative management, and discuss surgical outcomes using a specified program.

  12. Neurolinguistic Aspects of Finnish Posterior Aphasia.

    ERIC Educational Resources Information Center

    Niemi, Jussi; Koivuselka-Sallinen, Paivi

    Examination of the lexical errors (phonological paraphasias and neologisms) of two posterior aphasic patients who are speakers of Finnish, a highly synthetic language, revealed that the lexical difficulties generally typical of posterior aphasics were found in these patients as well. The typical lexical difficulties clustered around open class…

  13. Management of a dislocated endovascular aneurysm repair in a challenging giant abdominal aortic aneurysm.

    PubMed

    Geers, Joachim; Daenen, Geert; Stabel, Patrick

    2016-02-01

    Introduction A case report of a contained rupture of an abdominal aneurysm, treated by endovascular technique (EVAR), but complicated by perioperative endoprosthesis limb dislocation. Case report An 81-year old male presented at the emergency department with a contained rupture of an infrarenal aortic aneurysm and bilateral extensive iliac aneurysmatic disease. Open repair was no option, due to the pulmonary condition. The patient was prepped for an emergency EVAR. After placing a bifurcated endoprosthesis, angiography revealed a type IIIa endoleak, due to a dislocation between two left iliac extensions. We converted to a right-sided aorto-uni-iliac endoprosthesis with a femorofemoral bypass. A postoperative CT-scan showed a complete exclusion of the aneurysm, a patent aorto-uni-iliac endoprosthesis and a femorofemoral bypass without an endoleak. Discussion EVAR is feasible with a hostile neck AAA, even in a ruptured AAA. In large AAA, one should consider an overlap larger than suggested in the instructions for use. PMID:27385140

  14. Proximal clamping levels in abdominal aortic aneurysm surgery.

    PubMed Central

    Büket, S; Atay, Y; Islamoğlu, F; Yağdi, T; Posacioğlu, H; Alat, I; Cikirikçioğlu, M; Yüksel, M; Durmaz, I

    1999-01-01

    In the surgical treatment of abdominal aortic aneurysm, the single proximal cross-clamp can be placed at 3 alternative aortic levels: infrarenal, hiatal, and thoracic. We performed this retrospective study to evaluate the advantages and disadvantages of the 3 main aortic clamping locations. Eighty patients presented at our institution with abdominal aortic aneurysms from March 1993 through May 1998. Fifty of these patients had intact aneurysms and underwent elective surgery, and 30 had ruptured aneurysms that necessitated emergency surgery. Proximal aortic clamping was applied at the infrarenal level in 24 patients (22 from the intact aneurysm group, 2 from the ruptured group), at the hiatal level in 34 patients (22 intact, 12 ruptured), and at the thoracic level (descending aorta) via a limited left lateral thoracotomy in 22 patients (6 intact, 16 ruptured). Early mortality rates (within 30 days) were 4% (2 of 50 patients) among patients with intact aneurysms and 40% (12 of 30 patients) among those with ruptured aneurysms. In the 2 patients from the intact aneurysm group, proximal aortic clamps were applied at the hiatal level. In the ruptured aneurysm group, proximal aortic clamps were placed at the thoracic level in 10 patients, the infrarenal level in 1, and the hiatal level in 1. According to our study, the clinical status of the patient and the degree of operative urgency--as determined by the extent of the aneurysm--generally dictate the proximal clamp location. Patients who present with aneurysmal rupture or hypovolemic shock benefit from thoracic clamping, because it restores the blood pressure and allows time to replace the volume deficit. Infrarenal placement is advantageous in patients with intact aneurysms if there is sufficient space for the clamp between the renal arteries and the aortic aneurysm. In patients with juxtarenal aneurysms, hiatal clamping enables safe and easy anastomosis to the healthy aorta. Clamping at this level also helps prevent

  15. Small Intracranial Aneurysm Treatment Using Target ® Ultrasoft ™ Coils

    PubMed Central

    Jindal, Gaurav; Miller, Timothy; Iyohe, Moronke; Shivashankar, Ravi; Prasad, Vikram; Gandhi, Dheeraj

    2016-01-01

    Purpose The introduction of small, soft, complex-shaped microcoils has helped facilitate the endovascular treatment of small intracranial aneurysms (IAs) over the last several years. Here, we evaluate the initial safety and efficacy of treating small IAs using only Target® Ultrasoft™ coils. Materials and methods A retrospective review of a prospectively maintained clinical database at a single, high volume, teaching hospital was performed from September 2011 to May 2015. IAs smaller than or equal to 5.0 mm in maximal dimension treated with only Target® Ultrasoft™ coils were included. Results A total of 50 patients with 50 intracranial aneurysms were included. Subarachnoid hemorrhage from index aneurysm rupture was the indication for treatment in 23 of 50 (46%) cases, and prior subarachnoid hemorrhage (SAH) from another aneurysm was the indication for treatment in eight of 50 (16%) cases. The complete aneurysm occlusion rate was 70% (35/50), the minimal residual aneurysm rate was 14% (7/50), and residual aneurysm rate was 16% (8/50). One intraoperative aneurysm rupture occurred. Three patients died during hospitalization from clinical sequelae of subarachnoid hemorrhage. Follow-up at a mean of 13.6 months demonstrated complete aneurysm occlusion in 75% (30/40) of cases, near complete occlusion in 15% (6/40) of cases, and residual aneurysm in 10% (4/40) of cases, all four of which were retreated. Conclusion Our initial results using only Target® Ultrasoft™ coils for the endovascular treatment of small intracranial aneurysms demonstrate initial excellent safety and efficacy profiles. PMID:27403224

  16. Rapid virtual stenting for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Zhao, Liang; Chen, Danyang; Chen, Zihe; Wang, Xiangyu; Paliwal, Nikhil; Xiang, Jianping; Meng, Hui; Corso, Jason J.; Xu, Jinhui

    2016-03-01

    The rupture of Intracranial Aneurysms is the most severe form of stroke with high rates of mortality and disability. One of its primary treatments is to use stent or Flow Diverter to divert the blood flow away from the IA in a minimal invasive manner. To optimize such treatments, it is desirable to provide an automatic tool for virtual stenting before its actual implantation. In this paper, we propose a novel method, called ball-sweeping, for rapid virtual stenting. Our method sweeps a maximum inscribed sphere through the aneurysmal region of the vessel and directly generates a stent surface touching the vessel wall without needing to iteratively grow a deformable stent surface. Our resulting stent mesh has guaranteed smoothness and variable pore density to achieve an enhanced occlusion performance. Comparing to existing methods, our technique is computationally much more efficient.

  17. Rapid Virtual Stenting for Intracranial Aneurysms

    PubMed Central

    Zhao, Liang; Chen, Danyang; Chen, Zihe; Wang, Xiangyu; Paliwal, Nikhil; Xiang, Jianping; Meng, Hui; Corso, Jason J.; Xu, Jinhui

    2016-01-01

    The rupture of Intracranial Aneurysms is the most severe form of stroke with high rates of mortality and disability. One of its primary treatments is to use stent or Flow Diverter to divert the blood flow away from the IA in a minimal invasive manner. To optimize such treatments, it is desirable to provide an automatic tool for virtual stenting before its actual implantation. In this paper, we propose a novel method, called ball-sweeping, for rapid virtual stenting. Our method sweeps a maximum inscribed sphere through the aneurysmal region of the vessel and directly generates a stent surface touching the vessel wall without needing to iteratively grow a deformable stent surface. Our resulting stent mesh has guaranteed smoothness and variable pore density to achieve an enhanced occlusion performance. Comparing to existing methods, our technique is computationally much more efficient. PMID:27346910

  18. [Giant vertebro-basilar aneurysm. Frontal syndrome].

    PubMed

    Rosa, A; Mizon, J P; Sevestre, H

    1991-01-01

    A 72-year-old man presented with an apparent frontal syndrome. He also had bilateral trigeminal neuralgia, a pyramidal syndrome of all 4 limbs, balance disturbances, a horizontal nystagmus when looking to the left and a right velopalatine paralysis. CT scan with contrast showed a hyperdense rounded lesion in the left cerebello-pontine angle. Cerebral angiography showed this to be a large aneurysm of the end of the vertebral arteries. The patient died suddenly. Autopsy confirmed the site and presence of the aneurysm. Balance disturbances, the pyramidal syndrome and velopalatine paralysis could all be explained by brain stem compression and the bilateral nature of the trigeminal neuralgia by compression of the trigemino-thalamic tract. The apparent frontal syndrome, the authors suggest could have resulted from subacute raised intracranial pressure.

  19. Surgical Procedures for Renal Artery Aneurysms

    PubMed Central

    Inoue, Yoshinori; Kudo, Toshifumi; Toyofuku, Takahiro

    2012-01-01

    Objective: The aim of this study was to assess the strategy and surgical procedures for treating a renal artery aneurysm (RAA). Patients and Methods: We retrospectively reviewed the surgical strategy for 21 cases with RAA between 2001 and 2010 at this institution. Treatment was indicated for patients with an RAA larger than 2 cm and/or symptoms. Surgical treatment was the initial strategy, and coil embolization was indicated in the case of narrow-necked, saccular, extraparenchymal aneurysms. Results: Fifteen patients in 21 cases received an aneurysmectomy and renal artery reconstruction with an in-situ repair. One patient underwent an unplanned nephrectomy, and coil embolization was performed in 5 patients. Conclusion: In-situ repair was safe and minimally invasive. RAA, even in the second bifurcation, could be exposed by a subcostal incision, and the transperitoneal approach permitted the safe treatment of an RAA with acceptable results, in our simple preservation of renal function. PMID:23555504

  20. Cardiovocal Syndrome Secondary to an Aortic Aneurysm.

    PubMed

    Wang, Hsing-Won; Chen, Mei-Chien; Chao, Pin-Zhir; Lee, Fei-Peng

    2016-01-01

    We reported that a 68-year-old man presented to the ENT outpatient department complaining of hoarseness for more than 10 months. Clinical exam identified left vocal palsy in the paramedian position and atrophic vocal folds were noted. Chest radiography revealed a large bulging contour overlying aorta and left hilar shadow. Aortic aneurysm was proved by CT scanning. Contrast-enhanced chest computed tomography for further evaluation showed a broad-based aortic aneurysm at proximal descending aorta, projecting anterolaterally. Cardiovocal syndrome was proved. The syndrome is a rare clinical presentation. While a patient with unilateral vocal palsy is encountered, one might keep in mind the possibility of cardiovocal syndrome especially in an adult who had a cardiovascular disease. PMID:27088024