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Nakada R, Sakuta K, Sato T, Okumura M, Kida H, Yamamoto S, Takahashi J, Kitagawa T, Takatsu H, Miyagawa S, Komatsu T, Sakai K, Mitsumura H, Yaguchi H, Iguchi Y. Intracranial atherosclerotic disease mechanism indicates poor outcomes of thrombectomy in acute cerebral infarction with large vessel occlusion: A matched cohort study. J Neurol Sci 2024; 466:123235. [PMID: 39303349 DOI: 10.1016/j.jns.2024.123235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 09/08/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Thrombectomy is a standard treatment for acute large vessel occlusion (LVO); however, its effectiveness in treating LVO related to intracranial atherosclerosis disease (ICAD) remains uncertain. This study aimed to compare thrombectomy outcomes in ICAD-related and embolic LVO, focusing on patients with similar symptom severities upon hospital admission. METHODS This retrospective study was conducted at Jikei University Hospital and Jikei University Kashiwa Hospital between October 2017 and March 2023. Ischemic stroke patients with LVO who underwent thrombectomy were categorized into ICAD and embolism groups based on the occlusion mechanism. Groups were matched using National Institutes of Health Stroke Scale scores at the time of admission. A modified Rankin Scale score of 5 or 6 at 90 days after symptom onset was defined as a devastating outcome. The procedural outcomes and frequency of devastating outcomes were compared between the ICAD and embolism groups. RESULTS The study included 33 matched pairs were included. The ICAD group showed lower rates of successful reperfusion (43 % vs. 82 %, p = 0.001), and longer procedural times (median 88 min vs. 50 min, p < 0.001) than the embolism group. The ICAD group had a significantly higher frequency of devastating outcomes than the non-ICAD group (39 % vs. 15 %, p = 0.027). Multivariate analysis identified ICAD as an independent factor associated with devastating outcomes (OR, 3.804; 95 % confidence interval (95 %CI), 1.148-12.603; p = 0.029). CONCLUSION In thrombectomy therapy, reperfusion rates and outcomes are significantly worse in patients with ICAD-LVO than in patients with embolic LVO.
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Affiliation(s)
- Ryoji Nakada
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan.
| | - Kenichi Sakuta
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Takeo Sato
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Motohiro Okumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kida
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sumire Yamamoto
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Junichiro Takahashi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomomichi Kitagawa
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Takatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Miyagawa
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Mitsumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Yaguchi
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
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Takase Y, Tanaka T, Goto H, Momozaki N, Honda E, Abe T, Matsuno A. Delayed Rupture from a Pseudoaneurysm after Mechanical Thrombectomy: A Case Report. Asian J Neurosurg 2024; 19:556-562. [PMID: 39205896 PMCID: PMC11349398 DOI: 10.1055/s-0044-1787672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Pseudoaneurysm following mechanical thrombectomy (MT) is a rare but possible complication associated with endovascular procedures. This report presents a case of delayed rupture of a pseudoaneurysm after MT with a stent retriever, which was confirmed by open surgery. During hospitalization, an 85-year-old woman had right hemiplegia and aphasia. Magnetic resonance imaging and angiography revealed acute ischemic changes in the left middle cerebral artery because of M2 segment occlusion. MT was performed to address persistent M2 occlusion. Retrieving from distal vessels with the fully deployed Solitaire 4 × 20 mm stent retriever was considered dangerous, we resheathed the stent, but the microcatheter jumped distally. Angiography through microcatheter revealed contrast leakage into the subarachnoid space. The diagnosis was vessel perforation caused by the microcatheter. The lesion was treated with temporary balloon occlusion for 5 minutes using a balloon-guiding catheter, combined with the reversal of heparin anticoagulation by protamine, and a systolic blood pressure reduction to below 120 mm Hg. Anticoagulation was initiated after confirming that postprocedural subarachnoid hemorrhage (SAH) decreased 1 day after the procedure. Fourteen days after the procedure, computed tomography and angiography revealed a massive hematoma with a newly formed small pseudoaneurysm at the site of vessel rupture. Open surgery was performed to close the small artery rupture using a clip. Delayed rupture of the pseudoaneurysm occurred after MT using a stent retriever. If SAH is observed after MT, performing follow-up computed tomography angiography or magnetic resonance angiography is recommended to consider pseudoaneurysm formation.
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Affiliation(s)
- Yukinori Takase
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Okawa, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Okawa, Japan
- Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hirofumi Goto
- Department of Neurology, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Nobuaki Momozaki
- Department of Neurosurgery, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Eiichiro Honda
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, Japan
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Sasaki I, Imahori T, Yano T, Onobuchi K, Gomi M, Kuroda J, Kobayashi N, Sato K, Niwa Y, Iwasaki K, Hasegawa H. Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment. Radiol Case Rep 2023; 18:150-155. [PMID: 36345459 PMCID: PMC9636005 DOI: 10.1016/j.radcr.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Intracranial artery dissection is an uncommon but possible cause of ischemic stroke, and is usually diagnosed based on imaging findings such as mural hematoma and dissection flap. However, it is challenging to recognize the underlying dissection in cases of acute large vessel occlusion. In this report, we present a case of acute internal carotid artery occlusion, in which the underlying dissection of the paraclinoid segment was found during the thrombectomy procedure. Two thrombectomy procedures failed to recanalize the acute internal carotid artery occlusion without removing any clot. Angiography performed during a Trevo stent retriever deployment in the first pass showed obscure contrast defects in the stent strut with temporary flow restoration. In the next pass, the appearance of the contrast defects changed and a parallel linear contrast appeared on the outside of the vessel wall. These angiographic findings were identified as mural hematoma and dissection flap, indicating dissection of the paraclinoid as the cause of the occlusion. During antiplatelet loading and preparation of a dedicated intracranial stent, the Trevo stent retriever was left deployed again at the occlusion site to maintain the blood flow. After permanent stenting with an Enterprise stent, angiography revealed complete recanalization. The patient recovered fully after the procedure. In the present case, stent retriever deployment revealed the hallmarks of dissection on angiography, such as mural hematoma, dissection flap, and temporal morphological changes, by restoring the blood flow temporarily. Such angiographic findings can provide useful information on the occlusion characteristics and real-time feedback for optimal treatment strategy.
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Tsunoda S, Inoue T, Matsufuji H, Segawa M, Akabane A. Traumatic pseudoaneurysm resulting from avulsion of the falcine branch of an azygos anterior cerebral artery: a case report. Acta Neurochir (Wien) 2022; 164:2441-2445. [PMID: 35906354 DOI: 10.1007/s00701-022-05329-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022]
Abstract
Traumatic anterior cerebral artery (ACA) aneurysms are extremely rare. Traumatic anterior ACA aneurysms are thought to develop when the ACA at the pericallosal segment travel adjacent to immobile falx cerebri. As the majority of aneurysms are pseudoaneurysms, direct neck clipping is usually not possible, and it is often necessary to carry out direct or endovascular trapping in conjunction with proficient bypass techniques. The authors describe the first reported case of a traumatic ACA pseudoaneurysm resulting from avulsion of the falcine branch of an azygos ACA. In this case, the lacerated aneurysm wall was successfully sutured, without the need for a bypass. Neurosurgeons should be aware that avulsion of the falcine branch arising from the ACA can occur, and that this may cause a traumatic aneurysm on the distal ACA. Furthermore, direct suturing of a lacerated arterial wall should be considered a treatment option for this type of traumatic intracranial aneurysm.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22Shinagawa-ku, Higashigotanda Tokyo, 141-0022, Japan.
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22Shinagawa-ku, Higashigotanda Tokyo, 141-0022, Japan
| | - Hiroshi Matsufuji
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22Shinagawa-ku, Higashigotanda Tokyo, 141-0022, Japan
| | - Masafumi Segawa
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22Shinagawa-ku, Higashigotanda Tokyo, 141-0022, Japan
| | - Atsuya Akabane
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22Shinagawa-ku, Higashigotanda Tokyo, 141-0022, Japan
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Sasaki I, Imahori T, Yano T, Gomi M, Kuroda J, Kobayashi N, Sato K, Niwa Y, IwasaKi K, Hasegawa H. Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion. Radiol Case Rep 2022; 17:1848-1852. [PMID: 35401893 PMCID: PMC8990047 DOI: 10.1016/j.radcr.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/04/2022] [Indexed: 10/26/2022] Open
Abstract
Mechanical thrombectomy is highly effective for the recovery of acute ischemic stroke with large vessel occlusion. However, refractory occlusions are still encountered despite the use of currently available devices. In this article, we present a case of refractory terminal internal carotid artery occlusion treated with the "crossing double stent retriever technique." Two thrombectomy procedures with the combined technique using a stent retriever and aspiration catheter failed to recanalize the terminal internal carotid artery occlusion that involved the dominant anterior cerebral artery. We then applied the crossing double stent retriever technique as a rescue technique. Two microcatheters were advanced across the occlusion: one to the anterior cerebral artery and the other to the middle cerebral artery. First, a Trevo NXT 4 mm stent retriever was deployed from the anterior cerebral artery. Next, an additional Trevo NXT 4 mm stent retriever was deployed from the middle cerebral artery, and full immediate restoration of flow was achieved on angiography. Intraprocedural radiological images showed that the 2 microcatheters traversed different pathways, and the 2 stent retrievers completely covered the entire vessel with apparent in-stent clot sign. Both stent retrievers were then pulled back together, and a hard clot was retrieved. Subsequent angiography revealed complete recanalization. The crossing double stent retriever technique seems an effective rescue technique for treating refractory terminal internal carotid artery occlusion, especially with the anatomical feature of branching of the dominant anterior cerebral artery. This technique can facilitate the device-clot-vessel interaction by engaging the clot via 2 different device pathways.
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Affiliation(s)
- Isao Sasaki
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Taichiro Imahori
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan
| | - Tatsuya Yano
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Junko Kuroda
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Norikata Kobayashi
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Kimitoshi Sato
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Yoji Niwa
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Koichi IwasaKi
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
| | - Hiroshi Hasegawa
- Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan
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6
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Shim DH, Do Y, Do JK, Youn SW. Delayed Rupture of an Anterior Communicating Artery Pseudoaneurysm Caused by Distal Occlusion Thrombectomy Using a Stent Retriever: A Case Report and Mechanism of Injury. Neurointervention 2022; 17:121-125. [PMID: 35535378 PMCID: PMC9256472 DOI: 10.5469/neuroint.2022.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/15/2022] [Indexed: 12/03/2022] Open
Abstract
We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.
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Affiliation(s)
- Dong-Hyun Shim
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Youngrok Do
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jin Kuk Do
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Sung Won Youn
- Department of Radiology, Daegu Catholic University Medical Center, Daegu, Korea
- Correspondence to: Sung Won Youn, MD, PhD Department of Radiology, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: +82-53-650-4328 Fax: +82-53-650-4339 E-mail:
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7
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Delgado Acosta F, Jiménez Gómez E, Bravo Rey I, Bravo-Rodríguez FDA, Valverde Moyano R, Oteros Fernández R. Influence of the number of passes of Stent-Retriever on the occurrence of parenchymal hematomas in stroke patients undergoing thrombectomy. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Nakahara M, Imahori T, Tanaka K, Okamura Y, Arai A, Yamashita S, Iwahashi H, Mori T, Sasayama T, Kohmura E. Iatrogenic intracranial vessel dissection during mechanical thrombectomy rescued by emergent stenting: 2 case reports. Radiol Case Rep 2021; 16:835-842. [PMID: 33552335 PMCID: PMC7847827 DOI: 10.1016/j.radcr.2021.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022] Open
Abstract
Intracranial vessel dissection is a procedural complication associated with endovascular treatment. However, there have been few reports on its potential causes and management during mechanical thrombectomy. In approximately 250 cases of mechanical thrombectomy over the past 5 years at our institution, iatrogenic intracranial dissection occurred in 2 patients (0.8%). In this report, we described these 2 cases that were rescued through emergent stenting. Mechanical thrombectomy, using both a stent retriever and an aspiration catheter, was performed for acute middle cerebral artery M2 occlusion in Patient 1 (a 69-year-old man) and for distal M1 occlusion in Patient 2 (an 83-year-old woman). In both cases, recanalization was achieved with the procedure, but irregular stenosis developed at the initially nonoccluded, but mildly arteriosclerotic, M1, after recanalization. During the thrombectomy procedure, the aspiration catheter sifted up to the arteriosclerotic M1. In both cases, the lesions were considered vessel dissection, due to a shift of the aspiration catheter tip into the arteriosclerotic vessel wall. Repeated percutaneous angiography with antithrombotic therapy failed to improve the lesions and to maintain the antegrade blood flow. Finally, lesions in each patient were successfully rescued through the use of emergent stenting. A drug-eluting stent for coronary use was deployed in Patient 1, and an Enterprise stent was applied in Patient 2. Inadvertent shift of the aspiration catheter into arteriosclerotic vessels can cause a serious intracranial vessel dissection. When performing mechanical thrombectomy, intracranial stents need to be available as rescue treatment devices to manage refractory iatrogenic intracranial vessel dissection.
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Key Words
- Acute ischemic stroke
- Aspiration catheter
- BGC, balloon-guide catheter
- CT, computed tomography
- DES, drug-eluting stent
- DWI, diffusion-weighted imaging
- Dissection
- ICA, internal carotid artery
- Large vessel occlusion
- MCA, middle cerebral artery
- MRA, magnetic resonance angiography
- MT, mechanical thrombectomy
- Mechanical thrombectomy
- NIHSS, National Institutes of Health Stroke Scale
- PCI, percutaneous coronary intervention
- PTA, percutaneous transluminal angioplasty
- SR, stent retriever
- Stent retriever
- TICI, thrombolysis in cerebral infarction
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Affiliation(s)
- Masahiro Nakahara
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Taichiro Imahori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan.,Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan.,Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Atsushi Arai
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Shunsuke Yamashita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Hirofumi Iwahashi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Tatsuya Mori
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
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Tamura T, Ota N, Okada Y, Valenzuela J, Noda K, Kamiyama H, Tanikawa R. Sylvian Hematoma Removal after the Stent-Retriever Thrombectomy Accompanied by Arteriole Avulsion: Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:94-99. [PMID: 37502806 PMCID: PMC10370804 DOI: 10.5797/jnet.cr.2020-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 07/29/2023]
Abstract
Objective We describe an instructive case of post-thrombectomy subarachnoid hemorrhage (PTSAH) by sylvian hematoma removal. Case Presentations An 83-year-old female presented with an acute cardiogenic right M1 occlusion. After the thrombectomy with combined stent retriever and aspiration technique with total five passes, TICI 2b reperfusion was achieved; however, CT imaging displayed subarachnoid hematoma (SAH) along the right sylvian fissure. Throughout the approach, contrast extravasation was not confirmed. The SAH grew up to become the sylvian hematoma; therefore, removal of the sylvian hematoma was conducted. An abrupt arteriole tear around the distal M2 of parietal artery was confirmed as bleeding point and those teared arteriole's stumps were electrically coagulated not to re-bleed. Conclusion We suggest that the PTSAH is possible even in invisible-extravasation cases and the sylvian hematoma removal is effective to elucidate the etiology of the PTSAH, and is a reliable method to prevent the re-bleeding and is anticipated to improve the prognosis. Craniotomy is required for medically resistant PTSAH after thrombectomy, and avulsion of the pial artery can be the cause.
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Affiliation(s)
- Takamitsu Tamura
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | | | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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Double Stent Retriever (SR) Technique: A Novel Mechanical Thrombectomy Technique to Facilitate the Device-Clot Interaction for Refractory Acute Cerebral Large Vessel Occlusions. World Neurosurg 2020; 141:175-183. [DOI: 10.1016/j.wneu.2020.05.268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
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11
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Zheng Y, Lu Z, Shen J, Xu F. Intracranial Pseudoaneurysms: Evaluation and Management. Front Neurol 2020; 11:582. [PMID: 32733358 PMCID: PMC7358534 DOI: 10.3389/fneur.2020.00582] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/20/2020] [Indexed: 12/04/2022] Open
Abstract
Intracranial pseudoaneurysms account for about 1% of intracranial aneurysms with a high mortality. The natural history of intracranial pseudoaneurysm is not well-understood, and its management remains controversial. This review provides an overview of the etiology, pathophysiology, clinical presentation, imaging, and management of intracranial pseudoaneurysms. Especially, this article emphasizes the factors that should be considered for the most appropriate management strategy based on the risks and benefits of each treatment option.
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Affiliation(s)
- Yongtao Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Zheng Lu
- Department of Neurosurgery, Hai'an People's Hospital, Nantong, China
| | - Jianguo Shen
- Department of Neurosurgery, Second Affiliated Hospital of Jiaxiang University, Jiaxing, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.,Department of Neurosurgery, Kashgar Prefecture Second People's Hospital, Kashgar, China
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12
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Imahori T, Koyama J, Tanaka K, Okamura Y, Arai A, Iwahashi H, Mori T, Yokote A, Matsushima K, Matsui D, Kobayashi M, Hosoda K, Kohmura E. Impact of introducing endovascular treatment on acute ischemic stroke outcomes: A shift from an era of medical management to thrombectomy in Japan. Heliyon 2020; 6:e03945. [PMID: 32426544 PMCID: PMC7226659 DOI: 10.1016/j.heliyon.2020.e03945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/24/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Endovascular treatment (EVT) has increasingly become the standard treatment of acute cerebral large vessel occlusion (LVO). We evaluated the impact of introducing EVT on LVO therapy in a single center where intravenous thrombolysis (IVT) had been the only recanalization therapy. Materials and methods Between April 2013 and March 2017, 354 consecutive patients with LVO admitted to our institution were analyzed. We compared outcomes between two chronological groups before (Pre-EVT group) and after (Post-EVT group) introducing EVT in April 2015. We assessed prognostic factors for favorable outcomes (modified Rankin scale score ≤2 at 90 days). Results In the Pre-EVT group, all 140 patients were treated medically, including 30 patients (21%) undergoing IVT. In the Post-EVT group, 118 patients (55%) underwent EVT, and the remaining 96 patients treated medically, including six patients (3%) undergoing IVT. The proportion undergoing recanalization therapy with IVT or EVT significantly increased after introducing EVT (21% versus 58%, p < 0.001). The rate of patients achieving favorable outcomes also significantly increased (14% versus 31%, p < 0.001). In multivariate regression analysis, introducing EVT was an independent predictive factor after adjusting for age, stroke severity and extent, and time (p = 0.005). The arrival time in patients with helicopter transport was significantly shorter than that with ground ambulance for a distance of more than 10 km (p < 0.001). Conclusions This study demonstrated that the introduction of EVT improved outcomes of acute LVO patients, increasing the opportunity to receive recanalization therapy. Further efforts to establish medical systems to provide EVT are required throughout the country.
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Affiliation(s)
| | - Junji Koyama
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Atsushi Arai
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | - Tatsuya Mori
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | | | - Daisaku Matsui
- Tajima Emergency & Critical Care Medical Center, Toyooka Hospital, Hyogo, Japan
| | - Makoto Kobayashi
- Tajima Emergency & Critical Care Medical Center, Toyooka Hospital, Hyogo, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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