1/11. Embolization of meningohypophyseal and inferolateral branches of the cavernous internal carotid artery.BACKGROUND AND PURPOSE: Despite the continued improvements in endovascular techniques this decade, few dedicated studies addressing the feasibility of such procedures or their efficacy relative to risk have been conducted. The purpose of this study was to use current endovascular techniques to assess the feasibility, effectiveness, and safety of direct selective catheterization and embolization of the small branches of the cavernous segment of the internal carotid artery. methods: We retrospectively reviewed the findings in 10 patients with lesions (five meningiomas and five arteriovenous malformations) primarily or partly supplied by branches of the meningohypophyseal trunk or inferolateral trunk who had undergone endovascular embolization of the feeding arteries during the period from 1991 to 1997. In each case, the artery was selectively catheterized with a microcatheter/microguidewire system and embolized with polyvinyl alcohol particles (n = 5), n-butyl cyanoacrylate tissue adhesive (n = 4), or both (n = 1). RESULTS: In all 10 patients, the feeding artery from the meningohypophyseal trunk (eight patients) or inferolateral trunk (three patients; one patient with both) was successfully catheterized and embolized. In nine patients, embolization resulted in complete obliteration of the vascular territory; in the remaining patient, blood supply was decreased by an estimated 80%. No immediate or delayed complications occurred. CONCLUSION: Advances in microcatheter and microguidewire technology allow more efficient and safer selective catheterization and embolization of branches of the cavernous segment of the internal carotid artery than in the recent past. Meticulous technique and detailed knowledge of the vascular anatomy of the cavernous sinus region are necessary to maximize lesion devascularization and to minimize the risk of stroke, cranial nerve palsies, and blindness.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/11. Management of neuroform stent dislodgement and misplacement.A self-expanding stent has recently been introduced for the treatment of wide-neck aneurysms. We describe two cases of stent malposition within large aneurysms. In the first case, the stent was dislodged during microcatheterization. This was managed by placement of a second stent through the interstices of the first followed by aneurysm coiling. In the second case, after deployment, the proximal portion of the stent moved into the aneurysm as the exchange guidewire was removed. This patient was treated by vessel sacrifice.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
3/11. External carotid artery aneurysm developing after embolization of a ruptured posterior inferior cerebellar artery aneurysm in a patient with cervicocephalic fibromuscular dysplasia--case report.A 30-year-old man presented with an aneurysm of the left posterior inferior cerebellar artery manifesting as subarachnoid hemorrhage and cerebellar infarction. angiography demonstrated string-of-beads sign typical of fibromuscular dysplasia (FMD) in the extracranial carotid and vertebral arteries. The aneurysm and the parent artery were successfully embolized with Guglielmi detachable coils. Severe vasospasm developed 1 week after admission, and was treated several times by selective injection of vasodilator. A new aneurysm of the left external carotid artery became evident 1 month later, whereas only slight dilation had previously been apparent. This angiographic sequence demonstrated a new arterial dissection. Despite the possibility of damage to the artery during multiple catheterizations, arterial wall changes caused by FMD appear to have been primarily responsible. This case emphasizes the need for particular care in performing vascular interventional procedures in the presence of FMD.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
4/11. Central retinal and posterior ciliary artery occlusion after particle embolization of the external carotid artery system.A 15-year-old boy underwent neuroradiologic embolization of the left internal maxillary artery with polyvinyl alcohol to stop traumatic epistaxis after failure of surgical clipping and nasal packing. Selective catheterization of the external carotid artery before embolization showed a faint choroidal blush. Although the procedure provided hemostasis, embolization to the central retinal artery and ciliary arteries resulted in loss of vision. The route of the emboli to the eye was via the anastomotic network of the lacrimal artery supplied by the external carotid artery system. Neuroradiologic embolization of the external carotid artery is an effective mode of therapy for dural-cavernous fistulas when fed by the external carotid artery system. Because the blood flow to the brain and eye is predominantly supplied by the internal carotid artery, embolization of the external carotid artery is considered relatively safe. The authors document the importance of recognition of the choroidal blush during selective external carotid artery angiography as a sign of collateral blood flow to the eye. physicians and patients need to be aware of the risk of blindness as a complication of external carotid artery embolization when this sign is present.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
5/11. Occlusion of arteriovenous malformations of the cavernous sinus via the superior ophthalmic vein.The treatment of five patients with dural arteriovenous malformations (AVMs) of the cavernous sinus via the superior ophthalmic vein (SOV) is reported. The procedure was performed by transcutaneous puncture of the SOV under the guidance of real-time digital subtraction angiography. Complete resolution of the ocular symptoms was achieved in all cases. Angiograms after embolization showed complete obliteration of the malformation in four cases and partial obliteration in one. This method can cure dural AVMs of the cavernous sinus, with preservation of blood flow in the internal carotid artery. It is particularly indicated when the SOV is enlarged and when (1) dural AVMs of the cavernous sinus are fed by small branches of the internal carotid artery or direct carotid cavernous fistulas with small tears; (2) dural AVMs of the cavernous sinus are fed by multiple branches from both the internal and external carotid arteries, one or both sides; or (3) dural AVMs of the cavernous sinus or direct carotid cavernous fistulas recur after trapping of the internal carotid artery. Transcutaneous puncture and catheterization of the SOV was performed safely with the aid of digital subtraction angiography. The SOV approach was able to treat the fistula with preservation of the internal carotid artery.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
6/11. Subtemporal transdural use of detachable balloons for traumatic carotid-cavernous fistulas.Endovascular use of detachable balloons has revolutionized the management of carotid-cavernous fistulas so that the goals of angiographic elimination of fistula and preservation of carotid patency can usually be achieved nonsurgically. Certain circumstances of flow dynamics and anatomy, however, make an endovascular approach difficult for even an experienced interventional neuroradiologist. Fistulas involving the posterior carotid wall at its proximal cavernous entry and the anterior carotid wall in its initial horizontal intracavernous segment, as well as very low flow fistulas at other sites, have posed particular problems. Three patients with such traumatic fistulas whose endovascular treatment failed were managed by the direct transdural introduction of balloons. Intraoperative angiography was accomplished with open internal carotid artery (ICA) catheterization and the use of a portable C-arm with a 6-in. image intensifier. After temporal craniectomy and subtemporal exposure, the course of the cavernous ICA was mapped out with spinal needles and the site of the fistula was localized by intraoperative angiography. An incision was then made in the lateral wall of the cavernous sinus, and latex balloons were manually introduced via a 7 French introducer sheath. The balloons were inflated under angiographic control and detached when the fistula was obliterated. This simple technique was initially successful in three patients; the fistula was eliminated with preservation of carotid patency. One patient suffered a recurrence of his fistula 2 months postoperatively while lifting weights, and one patient developed a new 3rd nerve palsy after operation.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
7/11. Cerebrovascular occlusion by catheterization and embolization: clinical experience.Intravascular occlusion by various catheterization techniques was used to treat 27 cases of carotid-cavernous fistula, giant intracavernous aneurysm, and cerebral or dural arteriovenous malformation. Several case reports are presented. The detachable balloon technique proved valuable in the treatment of traumatic carotid-cavernous fistula and giant aneurysm. Calibrated-leak balloon catheterization with fluid embolization was used to treat cerebral arteriovenous malformation. Selection of embolic material is discussed.- - - - - - - - - - ranking = 3keywords = catheterization (Clic here for more details about this article) |
8/11. Management of carotid-cavernous fistulas by surgery combined with interventional radiology. Report of two cases.Two cases of carotid-cavernous fistulas were successfully treated by standard interventional radiology techniques after otherwise inaccessible vessels were surgically exposed. In the first case, an internal carotid artery (ICA), which had previously been ligated as part of an attempted surgical "entrapment" procedure, was recanalized to permit passage of a detachable balloon catheter to the fistula, resulting in its obliteration. In the second case, an enlarged superior ophthalmic vein was exposed and isolated to facilitate retrograde catheterization of the cavernous sinus and obliteration of a dural fistula between the ICA and the cavernous sinus by steel Gianturco coils. The methods and complications of both procedures are discussed.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
9/11. Pulmonary arteriovenous fistulas in association with hereditary hemorrhagic telangiectasia and carotid aneurysm.A case is presented of a patient with multiple bilateral pulmonary arteriovenous fistulas, hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease), and an intracranial carotid aneurysm. Over a twenty-five year period, the patient has survived several life-threatening complications, and has successfully undergone staged bilateral pulmonary lobectomies and clipping of the carotid aneurysm. Preoperative evaluation included cardiac catheterization studies both with and without temporary balloon occlusion of the pulmonary artery. The pathogenesis, clinical features, pathophysiologic changes, and treatment of pulmonary arteriovenous fistulas are discussed.- - - - - - - - - - ranking = 0.5keywords = catheterization (Clic here for more details about this article) |
10/11. Spiral spring effect in catheters as a complicating factor of femorocerebral catheterization.This paper describes a complication of selective femorocerebral catheterization which was due to iatrogenic embolization of atherosclerotic material originating from the bifurcation of the common carotid artery. After analysis of the catheter maneuvers inherent to the special shape of the type of catheter used (Sidewinder, Cordis Corporation), it is concluded that this complication resulted from incorrect catheter manipulation and an incorrect choice of the dimensions of the preshaped part of the catheter in relation to the diameter of the aortic arch. Two recommendations to avoid this complication are made.- - - - - - - - - - ranking = 2.5keywords = catheterization (Clic here for more details about this article) |
| | Next -> |