Contrast-induced Encephalopathy after Endovascular Embolization of an Anterior Communicating Artery Aneurysm:Case Report and Literature Review

We report a case of contrast-induced encephalopathy after endovascular embolization of an anterior communicating artery aneurysm.A 59-year-old woman was admitted to Tongliao Hospital for neurointerventional treatment due to a left anterior communicating artery aneurysm.She had a history of hypertension,which was controlled by regular medication.The contraindications were eliminated following a preoperative examination,and head computed tomography(CT)showed no abnormalities.After evaluation,interventional embolization was performed.Three hours postoperatively,the patient complained of a headache on the right side,which was accompanied by frequent nausea.Emergency head CT showed no intracranial hemorrhage,obvious brain tissue edema in the right cerebral hemisphere,blurred sulcus/gyrus,or metal artifacts(spring coils)in the left frontal lobe.The patient was diagnosed with contrast-induced encephalopathy(CIE).This patient achieved good prognosis through timely and reasonable treatment.CIE is very rare clinically,improper treatment may lead to irreversible clinical outcomes;it should cause alarm to doctors.

Endovascular coil embolization of parent artery for giant intracranial basilar dissection:a case report and literature review

Objective The purpose of the current study was to evaluate the method and result of endovascular treatment for a giant unruptured dissection of the basilar artery (BA) . Methods A 14-year-old boy underwent computed tomography (CT) scan following a minor head trauma was incidentally found a lesion located

Clinical evaluation of timing of endovascular embolization treatment for intracranial aneurysm

Objective To evaluate the effects of endovascular embolization treatment for intracranial aneurysms in different time. Methods The clinical data of 165 cases of ruptured intracranial aneurysm treated by endovascular treatment were analysed retrospectively. The patients were divided into 3 groups accrodding to

Mechanical compression management of the right middle cerebral artery inferior trunk using a stent during coil embolization of middle cerebral artery aneurysms:A case report and literature review

Endovascular coil embolization is a minimally invasive,rapid,and effective method for the treatment of intracranial aneurysms.However,complications associated with coil embolization,such as intraoperative aneurysm rupture or arterial occlusion,should be promptly managed during the procedure to avoid catastrophic consequences.This study presents a case of mechanical compression management of the right middle cerebral artery(MCA)inferior trunk during coil embolization for bilateral MCA aneurysms.The inferior trunk of the right MCA was abruptly occluded due to mechanical compression during coil embolization of the right MCA bifurcation aneurysm.A Solitaire AB stent(4×20 mm,Covidien/Medtronic,Dublin,Ireland)was implanted in the inferior trunk of the right MCA after tirofiban was injected via a microcatheter,and the right inferior trunk was recanalized.The patient also underwent coil embolization of the left MCA bifurcation aneurysm,without any complications.It is crucial to recognize compressive occlusion of adjacent aneurysm branches to avoid severe complications during intracranial aneurysm embolization.Stent placement is a rescue treatment option for recanalization of an occluded artery.

Life-threatening Spontaneous Retroperitoneal Haemorrhage:Role of Multidetector CT-angiography for the Emergency Management

Objective To evaluate the role of multidetector computed tomography-angiography(MDCTA) for management of life-threatening spontaneous retroperitoneal haemorrhage(SRH).Methods A retrospective analysis of the medical records of all SRH patients admitted to our hospital from January 1,2005 to November 31,2014 was performed.SRH was defined as unrelated to invasive procedures,surgery,trauma,abdominal tumor or aortic aneurysm.Life-threatening SRH was defined as hemodynamic instability with hypotension.Sixteen cases met the inclusive criteria.Patients' characteristics,clinical presentation,imaging of MDCTA,treatment modalities,morbidity,and follow-up data were analyzed.Results The group of 16 patients included 11 men and 5 women,with a mean age of 51.5 ± 16.4years.All patients underwent MDCTA scan examinations,and active contrast media(CM) extravasation were found in 9 patients.Angiography was performed for 8 patients in the CM extravasation group.Bleeding vessels were found in 7 patients who underwent successful embolization.One patient in the CM extravasation group did not undergo angiography and died of bleeding.Seven patients without active CM extravasation underwent conservative management.Bleeding was controlled for all these 7 patients,and 1 patient died of multiple organ failure.Fourteen patients survived from SRH were successfully discharged.One patient died of heart failure during follow-up.Conclusion MDCTA was useful in the diagnosis of SRH and proved to be predictive for the outcome of conservative treatment and early intervention.

Simultaneous embolization of a spontaneous porto-systemic shunt and intrahepatic arterioportal fistula:A case report

BACKGROUND Hepatic encephalopathy(HE)is a frequent and debilitating complication of chronic liver disease.Recurrent HE is strongly linked with spontaneous portosystemic shunts(SPSSs).Intrahepatic arterioportal fistulas(IAPFs)occur rarely but pose a major clinical challenge and may lead to or worsen portal hypertension.Herein,we present a rare case of recurrent HE secondary to a SPSS combined with an IAPF.CASE SUMMARY A 63-year-old female with primary biliary cirrhosis presented with recurrent disturbance of consciousness for 4 mo.SPSS communicating the superior mesenteric vein with the inferior vena cava and IAPF linking the intrahepatic artery with the portal vein were found on contrast-enhanced abdominal computed tomography.The patient did not respond well to medical treatment.Therefore,simultaneous embolization of SPSS and IAPF was scheduled.After embolization,the symptoms of HE showed obvious resolution.CONCLUSION The presence of liver vascular disorders should not be neglected in patients with chronic liver disease,and interventional therapy is a reasonable choice in such patients.

Classification and treatment strategy for Moyamoya disease-related aneurysms

Background Moyamoya disease(MMD)is a cerebrovascular disorder characterized by progressive unilateral or bilateral stenosis of the distal internal carotid artery.As hemodynamic features in MMD patients alter,the comorbidity of intracranial aneurysm(IA)is sometimes observed clinically.We aim to investigate clinical characteristics and therapeutic strategies for the comorbidity of Moyamoya disease with intracranial aneurysms(MMD-IA).Methods A total of 13 MMD-IA patients were recruited in this study and were manifested to be intracranial hemorrhage.We reviewed the surgical technique notes for all patients.Results According to the locations of an aneurysm,MMD-IA could be divided into several categories:(1)MMD-IA at a circle of Willis—aneurysms usually located at the trunk of Willis circle;(2)MMD-IA at collateral anastomosis—aneurysms located at the distal end of collateral anastomosis;and(3)MMA-IA at basal ganglia region.In this report,aneurysms in 10 patients located at Willis circle,2 at the pericallosal artery,and 1 at the basal ganglia region.Among them,endovascular embolism was performed among 5 patients.Aneurysm clipping was conducted among 7 patients.A patient with an aneurysm at the basal ganglia region just accepted revascularization treatment.All the treatments were successful.Follow-up studies,ranging from 6 to 24 months,demonstrated all patients received satisfactory curative effects.Conclusion Diverse clinical presentations could be observed among MMD-IA patients.Individualized neurosurgical treatments should be chosen according to the locations of the aneurysm.

Endovascular embolization of pulmonary arteriovenous malformations

Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients （n=-23） with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases. Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from （78.04＋8.22）% to （95.13＋3.67）% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization （t=9.101, P 〈0.001）. Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood oxygen saturation between 85% and 90%. Symptoms of hypoxia never recurred in the other cases. Conclusions Endovascular embolization of pulmonary arteriovenous malformations can significantly improve blood oxygen saturation and reduce serious complications such as cerebral infaction. Therefore, this kind of interventional procedure is a safe and effective treatment method with a low complication rate.

PERCUTANEOUS ENDOVASCULAR EMBOLIZATION OF INTRACEREBRAL ARTERIOVENOUS MALFORMATIONS EXPERIENCE IN 72 CASES

Endovascular therapeutic embolization of arteriovenous malformations (AVMs) of the brain was performed in 72 patients between October 1986 and March 1993. From October 1986 to May 1991, 38 patients in this series were treated with isobutyl-2-cyanoacrylate (IBCA) glue. After June 1991, in the remaining 34 patients the embolic materials used included surgical silk (5-0), polyvinyl alcohol (PVA), ethanol, and estrogen. After treatment, 29 patients (40.3%) had complete angiographic obliteration of AVM, 15 (21%) transient neurologic postembolization deficit, and 3 (4%) permanent deficit without death. Embolic agents and procedures are discussed as to their curative effects, safety, normal perfusion pressure breakthrough (NPPB) problem, with silk mixture fluid being considered preferable.

Safety and efficacy of stent placement for treatment of intracranial aneurysms： a systematic review

Objective To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms. Data sources We searched six databases, including Pubmed, Embase, SCI-expanded, the Cochrane Library, ISI Proceedings and ProQuest Dissertations ＆ Theses for the relevant studies using multiple key words from December, 1997 to February, 2009. Study selection Thirty-three studies about stent placement for intracranial aneurysms were identified, which reported data from a total of 1069 patients with 1121 intracranial aneurysms. Data extraction We prepared a standardized data extraction form （DEF）, which was used by two independent researchers to extract data from the included 33 studies. Results The overall initial complete occlusion rate was 52.5% （456/869, 95% CI： 49.2%-55.8%）. The overall complication rate was 14.3% （162/1130, 95% CI： 12.3%-16.4%）, of which 3.6% （38/1044, 95% CI： 2.5%-4.8%） were permanent. Clinical follow-up showed a dependence rate of 8.4% （39/465, 95% CI： 5.9%-10.9%）. Angiographic follow-up showed an improvement rate of 24.3% （117/481, 95% CI： 20.5%-28.2%） and a recurrence rate of 12.9% （62/481, 95% CI： 9.9%-15.9%）. Chi-squared tests were performed to compare the following subgroups： self-expandable vs. balloon-expandable stents, unruptured vs. acutely ruptured aneurysms, and with vs. without pre-medication. Statistical significance was reached in eight tests. Conclusions Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms. Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature. Patients with acutely ruptured aneurysms are more likely to be dependent, but not more likelv to suffer more orocedure-related comolications.

Bilateral carotid cavernous fistula after trauma:a case report and literature review

Background:Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures.The traumatic bilateral carotid cavernous fistula are significantly rarer.Case presentations:We report a case of a 61-year-old man presenting with unilateral exophthalmos,swollen eyelids,conjunctival congestion,and edema etiologically associated with severe trauma.Thereafter,the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture,such as ptosis of eyelid,dilated pupils,and eye movement disorder,and was diagnosed with bilateral carotid cavernous fistula.Conclusions:The patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas.The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula,in only one eye.Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.

Transarterial detachable coil embolization combined with ipsilateral intermittent carotid oppression for traumatic carotid-cavernous fistula with small fistula

One case of traumatic carotid-cavernous fistula （TCCF） with small fistula treated by transarterial detachable coil embolization was reported. The intermittent ipsilateral carotid compression was used to identify the final blocking of the residual fistula. The follow-up digital subtraction angiography showed that the TCCF was cured finally. From this case, we conclude that this method may be an effective way to treat TCCF with small fistula.