Total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism

AIM:To study the safety and feasibility of total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.METHODS:Fifteen consecutive patients with hypersplenism due to cirrhosis were enrolled in this study from January 2006 to June 2010.All patients underwent total embolization of the main splenic artery.Clinical symptoms,white blood cell(WBC) and platelet(PLT) counts,splenic volume,and complications of the patients were recorded.The patients were followed up for 1 and 6 mo,and 1,2,3 years,respectively,after operation.RESULTS:Total embolization of the main splenic artery was technically successful in all patients.Minor complications occurred in 13 patients after the procedure,but no major complications were found.The WBC andPLT counts were significantly higher and the residual splenic volume was significantly lower 1 and 6 mo,and 1,2,3 years after the procedure than before the procedure(P < 0.01).Moreover,the residual splenic volume increased very slowly with the time after embolization.All patients were alive during the follow-up period.CONCLUSION:Total embolization of the main splenic artery is a safe and feasible procedure and may serve as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.

Total splenic artery embolization for splenic artery aneurysms in patients with normal spleen

AIM: To evaluate total embolization of the main splenic artery in patients with splenic artery aneurysms (SAAs) and normal spleen.

Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

BACKGROUND Most intrahepatic arterioportal fistulae(IAPF)are acquired.The few cases of congenital fistulae are diagnosed in infants and children.CASE SUMMARY We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child.The patient had a 20-year history of abdominal distention and nausea.IAPF,along with splenomegaly and ascites,was found by Doppler sonography and confirmed by computed tomography angiography.The patient was treated with endovascular coil embolization,resulting in occlusion of the fistula.CONCLUSION This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.

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.

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

Endoscopic ultrasound-guided treatment of isolated gastric varices entwined with arteries:A case report

BACKGROUND Interventional endoscopic ultrasound is clinically used for the treatment of isolated gastric varices(IGVs)owing to its precise visualization.CASE SUMMARY A 39-year-old man was diagnosed with a large IGV during a routine physical examination.Endoscopic ultrasonography showed gastric varices entwined with an artery,which greatly increased the difficulty of treatment.We successfully treated the patient with endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection.CONCLUSION Endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection was safe and effective for the treatment of an IGV entwined with an artery.

Safety and efficacy of complete versus near-complete coiling in treatment of intracranial aneurysms

Objective:This study aimed to evaluate the clinical and angiographic outcomes of aneurysms that were completely or near-completely embolized and ascertain whether complete embolization is important in the stent-assisted coiling(SAC)of intracranial aneurysms.Methods:This retrospective study enrolled 390 patients(417 aneurysms).Among them,complete(100%)or nearcomplete(>90%)angiographic obliteration of the aneurysms on immediate angiography was accomplished.Baseline characteristics,complications,angiography follow-up results,and clinical outcomes were analyzed.Results:Cumulative adverse events occurred in 30 patients(7.7%),including thromboembolic complications in 17(4.4%),intraoperative rupture in 10(2.6%),and others in 3(0.8%).Statistical analyses revealed an increased intraprocedural rupture rate in the initial completely occluded aneurysms(5.6%compared with 1.0%).The incidence of cumulative adverse events was higher in patients with completely occluded aneurysms(11.1%)than in those with near-completely occluded aneurysms(5.5%).Angiography follow-up was available for 173 aneurysms.Aneurysm occlusion status at follow-up was correlated with stent placement(p?0.000,odds ratio?5.847),size(p?0.000,odds ratio?6.446 for tiny aneurysms;and p?0.001,odds ratio?5.616 for small aneurysms),and initial aneurysm occlusion status(p?0.001,odds ratio?3.436).Complete occlusion at followup was seen in 82.6%of the initial complete occlusion group versus 63.0%of the initial near-complete occlusion group.The incidence of complete occlusion at follow-up was higher in the initial completely occluded aneurysms with SAC(100%)than in the initial completely occluded aneurysms with non-SAC(65.2%).Conclusions:Initial complete treatment may lead to higher complication rates and good clinical outcomes at follow-up.Stent placement may enhance progressive aneurysm occlusion.Initial complete occlusion with SAC can provide durable closure at follow-up.

Acute onset of massive epistaxis due to post-traumatic cavernous internal carotid artery pseudoaneurysm: A case report

Rationale:Cavernous internal carotid artery(ICA)pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis.The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice.The management is often challenging because of anatomical inaccessibility of the bleeding point.Patient's concern:A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis.Diagnosis:A computerized tomography(CT)scan showed a fracture in the sphenoid sinus.CT angiogram revealed cavernous ICA pseudoaneurysm.Interventions:Endovascular coil embolization.Outcomes:The patient recovered well and was discharged without any neurological deficits Lessons:Cavernous ICA pseudoaneurysm may lead to a life-threatening situation.If a patient has a history of head trauma,post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.

Preoperative blood circulation modification prior to pancreaticoduodenectomy in patients with celiac trunk occlusion:Two case reports

BACKGROUND Celiac trunk stenosis or occlusion is a common condition observed in patients undergoing pancreaticoduodenectomy(PD).The risk of upper abdominal organ ischemia or failure increases if the blood circulation in the celiac arterial system is not maintained after the surgery.CASE SUMMARY We present two cases of elderly patients with distal cholangiocarcinoma and celiac trunk occlusion who underwent PD.We performed blood circulation modification preoperatively with transcatheter coil embolization of the arterial arcades of the pancreatic head via the superior mesenteric artery to develop collateral communication between the superior mesenteric artery and the common hepatic or splenic arteries to ensure arterial blood flow to the upper abdominal organs.The postoperative course was marked by delayed gastric emptying,but no major surgical complications,such as biliary or pancreatic fistula,or clinical,biochemical,or radiological evidence of ischemic disease,was observed.CONCLUSION Preoperative blood circulation modification may be a valid alternative procedure for elderly patients with celiac trunk occlusion who are ineligible for interventional or surgical revascularization.

Hemodynamic performance of coil embolization and stentassisted coil embolization treatments:a numerical comparative study based on subject-specific models of cerebral aneurysms

Hemodynamic characteristics such as blood velocity,blood pressure,flow impingement,wall shear stress and oscillatory shear index are considered to play important roles in the initiation,growth,rupture and recurrence of the cerebral aneurysms.Endovascular therapy is widely implemented to treat the cerebral aneurysms by releasing coils into the aneurysm sac for limiting the blood flow to the sac and stent-assisted coil embolization is adopted to occlude the wide-necked or complex aneurysms.Some researchers believe that stents are not only a mechanical device but may act as a biological system and contribute to vessel wall healing.Hemodynamics simulation helps people understand the effect of hemodynamic characteristics on the recurrence of the coiled aneurysm and it also benefits the interventional planning of neurosurgeons.This study constructed the numerical model for a subject-specific ICA aneurysm treated with stent-assisted coil embolization,which combined the coiled model of the aneurysm with a porous stent placement,and simulated the pulsatile blood flow in these aneurysm models.When a stent was placed across the aneurysm orifice in the coiled aneurysm,the high wall shear stress around the distal aneurysm root was reduced more than that of the coiled aneurysm without a stent.The simulated results point to the conclusion that the stent not only protects the parent artery from occlusion due to extension of coils or thrombosis,but may also reduce the recurrence risk of the stent-assisted coiled aneurysm.

Transcatheter coil embolization of multiple coronary artery-to-left ventricle fistulas： report of a rare case

Coronary artery fistula （CAF） is uncommon but remains the most frequent hemodynamically significant congenital coronary artery anomaly.The majority of fistula is single and drains into the right heart, only 3.5% into the left ventricle.^2 A large fistula requires closure to prevent complications such as myocardial ischemia resulting from coronary steal, congestive heart failure, endocarditis and potential aneurysmal dilatation and rupture.^3-5 Here we presented a rare case of CAF with multiple origins involving left anterior descending artery （LAD）, left circumflex branch （LCX） and right coronary artery （RCA）, and draining into the left ventricle, which was successfully closed by coil embolization.

Efficacy and safety of EUS-guided coil embolization in combination with cyanoacrylate injection versus conventional endoscopic cyanoacrylate injection in the treatment of gastric varices with spontaneous portosystemic shunts

Background:Gastric varices(GV)with spontaneous portosystemic shunts(SPSS)pose considerable risks and challenges for administering endoscopic cyanoacrylate(CYA)injection.This study aimed to evaluate the efficacy and safety of EUS-guided coil embolization in combination with CYA injection compared to conventional endoscopic CYA injection for managing GV with SPSS.Methods:This retrospective analysis included patients with SPSS treated with either EUS-guided coil embolization in combination with CYA injection or conventional CYA injection for gastric variceal bleeding at Ningbo Medical Center Lihuili Hospital(Zhejiang,China)between January 2018 and March 2023.Patient demographics,procedural details,and follow-up results were reviewed.Results:The study evaluated 57 patients:21 in the combined treatment group undergoing EUS-guided coil embolization in combination with CYA injection and 36 in the conventional group receiving conventional endoscopic CYA injection.Both cohorts achieved a 100%technical success rate.The mean volume of CYA used was significantly lower in the combined group(1.64±0.67mL)than in the conventional group(2.38±0.72mL;P<0.001).Early GV rebleeding rates did not differ significantly between the groups;in contrast,the combined treatment group exhibited a considerably lower incidence of late GV rebleeding than the conventional group(4.8%vs 27.8%,P=0.041).Conclusions:EUS-guided coil embolization in combination with CYA injection demonstrated superiority over conventional endoscopic CYA injection in reducing late GV rebleeding in treating GV with SPSS.

Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms

Background Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape,making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination of stents and coils. Methods From October 2000 to July 2001,eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling. Results Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting,and total occlusion was obtained in 13 cases,neck remnants in 3,and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization. Conclusions A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the long-term outcome.

Endovascular treatment of a giant internal carotid artery bifurcation aneurysm with drainage into cavernous sinus

This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus, which appeared following closed head trauma. A 39-year-old man suffered from a blunt head trauma in an automobile accident. Two weeks after the trauma, progressive chemosis of left eye was presented. Four months after the trauma, digital subtraction angiography showed an internal carotid artery bifurcation aneurysm, with drainage into the cavernous sinus. The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx. Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery. Endovascular treatment involving the use of coils combined with Onyx anneam to be a feasible and effective o[}tion for treatment of this hard-to-treat lesion.