1/17. basilar artery vasculitis secondary to sphenoid sinusitis--case report.A 35-year-old male presented with basilar artery vasculitis secondary to sphenoid sinusitis manifesting as rapidly deteriorating symptoms including consciousness disturbance and right hemiparesis. Computed tomography (CT) on admission showed sphenoid sinusitis without intracranial lesion. Emergency angiography demonstrated basilar artery stenosis. The neurological deterioration was considered to be caused by ischemia of the perforating arteries branching from the stenotic portion of the basilar artery. The patient was treated with urokinase infusion through a microcatheter just proximal to the stenosis 3 hours after the onset of the symptoms. His consciousness level and right hemiparesis markedly improved immediately after the procedure. Magnetic resonance (MR) imaging on day 5 revealed that extension of the sphenoid sinusitis into the prepontine cistern had formed an abscess which was attached to the clivus. The basilar artery was embedded in the abscess at the angiographic stenosis. cerebrospinal fluid (CSF) analysis showed white blood cell count of 601/mm3 with 82% neutrophils, 89.2 mg/dl protein, and 31 mg/dl glucose. No causative organism in the CSF could be identified by smear or culture. Early MR imaging and CSF examination are recommended when patients present with both ischemic symptoms involving the basilar artery and opacification of the sphenoid sinus on CT to identify basilar artery vasculitis secondary to sphenoid sinusitis.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/17. Proper management of the rotational vertebral artery occlusion secondary to spondylosis.A 66-year-old man with cervical spondylosis noticed severe vertigo when turning his head to the right. He underwent subclavian arteriography elsewhere, which showed a block of the contrast medium in the right vertebral artery (VA) at the C5/6 level when the patient turned his head to the right. After referral to our institute, however, postcontrast CT scan revealed an attenuated shadow of the venous plexus around the right VA at the C3/4 level. Repeated selective angiography with rotation of the head after visualization of the entire VA verified the level of obstruction to be at C3/4. Resection of the C4 transverse process through an anterior approach with drilling of the C3/4 spondylotic spur of the uncinate processi completely resolved the arterial impingement and the symptom. When evaluating rotational VA occlusion, dynamic angiography with selective catheterization is essential in determining which level is affected. The postcontrast CT scan is also useful because it suggests the level even without head rotation.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
3/17. Bypass combined with embolization via a venous graft in a patient with a giant aneurysm in the posterior communicating artery and bilateral idiopathic occlusion of the internal carotid artery in the neck.The authors describe the case of a patient with a symptomatic giant aneurysm of the posterior communicating artery (PCoA) associated with bilateral idiopathic occlusion of the internal carotid artery (ICA). The presence of severe tortuosity of the vertebral arteries (VAs), both at their origin from the subclavian artery and at the level of the third segment, impeded navigation of the catheter for embolization of the aneurysm with Guglielmi detachable coils (GDCs). A direct surgical approach was considered to be a high-risk procedure because of the bilateral occlusion of the ICAs and the size of the aneurysm. The following therapeutic strategy was therefore adopted: 1) balloon occlusion test of the left VA; 2) vertebro-vertebral bypass with saphenous vein graft to provide a pathway for subsequent embolization; 3) ICA-left middle cerebral artery bypass to ensure blood flow in the event that embolization resulted in closure of the PCoA; and 4) GDC embolization of the aneurysm via the posterior circulation graft to ensure complete exclusion of the lesion from the arterial circulation and preservation of the PCoA. At 3-month follow-up review the patient did not present with any neurological deficits; at 1-year control examination, magnetic resonance (MR) imaging and MR angiography both confirmed complete exclusion of the aneurysm and patency of the two bypasses.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/17. Acute basilar artery occlusion treated with combined intravenous Abciximab and intra-arterial tissue plasminogen activator: report of 3 cases.BACKGROUND: Acute vertebrobasilar occlusion remains a disease with a high mortality even after treatment by local intra-arterial fibrinolysis. Adjunctive treatment with platelet glycoprotein IIb/IIIa receptor inhibitors such as abciximab may facilitate recanalization and improve the neurological outcome. Results after treatment of 3 patients by combined intravenous abciximab and local intra-arterial tissue plasminogen activator (tPA) are reported. CASE DESCRIPTIONS: Treatment was performed within 6 hours of stroke onset. Angiography revealed embolic occlusion of the basilar artery in 2 patients and atherothrombotic occlusion at the vertebrobasilar junction in 1 patient. Therapy consisted of intravenous abciximab bolus administration (0.25 mg/kg) followed by 12-hour infusion therapy (0.125 microg/kg per minute) and local intra-arterial thrombolysis with tPA (10 mg/h). heparin was only applied for catheter flushing (500 IU/h). The patient with the atherothrombotic occlusion was treated with additional percutaneous transluminal angioplasty and stenting. Complete recanalization of the basilar artery occurred in 2 patients, whose conditions improved clinically to functional independence. In the third patient only partial recanalization was seen, with only slight clinical improvement. This patient died of cardiac failure 2 months later. Besides a subtle subarachnoid hemorrhage (n=1), no intracranial or extracranial bleeding complication was observed. CONCLUSIONS: The combination of glycoprotein IIb/IIIa receptor inhibitor with local intra-arterial tPA might be a promising therapy for patients with acute vertebrobasilar occlusion. Further studies are necessary to define the clinical benefit and the bleeding rate of this new pharmacological approach.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/17. Simultaneous ischemic and neurotoxic brain damage after coronary angiography.Transient cortical blindness following intra-arterial catheter angiography is a known rare complication. We report the case of a 56-year-old man who suffered from transient cortical blindness and neuropsychological deficits after coronary angiography. Serial CT scans revealed reversible pathologic parenchymal contrast enhancement of the right occipital lobe as well as left middle cerebral artery infarction at the same time. CT changes and time course of clinical symptoms are presented and discussed for both lesions of presumably different etiology.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
6/17. Skew deviation: a precursor to basilar artery thrombosis.The aim of this study was to describe skew deviation and vertical nystagmus as the initial signs for basilar artery thrombosis, a life-threatening disease. A 51-year-old woman complained of vertical diplopia for more than 20 h. A computed tomography of the brain was normal, but subsequently the patient developed additional symptoms including nausea, ventilation problems (dyspnoea) and somnolence. Neuro-ophthalmological evaluation revealed a skew deviation and a vertical nystagmus. magnetic resonance imaging allowed the diagnosis of basilar artery occlusion. An emergency intervention with cerebral catheter angiography and local intra-arterial thrombolysis was performed. Total recanalization of the basilar artery was achieved resulting in a complete neurological recovery, including the skew deviation and nystagmus. This rare case of skew deviation associated with basilar artery occlusion was a diagnostic challenge and highlights adequate differential diagnosis. Skew deviation is an important clinical sign. In this patient it was the key to a correct diagnosis enabling an immediate and successful intervention.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/17. Treatment of ischemic stroke complicating cardiac catheterization with systemic thrombolytic therapy.Ischemic stroke is a rare but serious complication of cardiac catheterization. We report a case in which systemic thrombolytic therapy was successfully utilized in treating a patient with a cerebellar stroke, leading to obtundation during elective cardiac catheterization. Underlying bilateral vertebrobasilar disease with thrombotic embolization to the basilar artery was postulated to be the pathophysiological basis for the stroke and subsequent success of thrombolytic treatment in this patient. As the consequences of this rare complication are severe, systemic thrombolytic therapy should be considered for patients suffering an acute ischemic stroke during cardiac catheterization or percutaneous coronary intervention.- - - - - - - - - - ranking = 7keywords = catheter (Clic here for more details about this article) |
8/17. Endovascular treatment of vertebral artery steal syndrome from an arteriovenous fistula between the internal mammary artery and superior vena cava.vertebrobasilar insufficiency resulting from subclavian steal syndrome and high flow through hemodialysis fistulas has been described. The present report describes a case of vertebral artery steal syndrome from an arteriovenous (AV) fistula between the right internal mammary artery and superior vena cava with the unusual pattern of antegrade flow through the vertebral artery in the setting of classic symptoms of steal. The AV fistula likely developed during earlier cardiac catheterizations. The patient presented with progressively worsening gait and limb ataxia. Angiography demonstrated the AV fistula and antegrade flow through the vertebral artery. Coil embolization of this high-flow fistula resulted in complete resolution of symptoms.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
9/17. 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 = 1keywords = catheter (Clic here for more details about this article) |
10/17. Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease.The poor prognosis of basilar artery occlusion is well known. Systemic anticoagulation rarely prevents a lethal outcome. A new therapeutic approach involves selective perfusion of streptokinase through the vertebrobasilar artery via a coaxial catheter system. Three of five reported cases demonstrated successful vascular recanalization with clinical improvement.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
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