Catheter Cerebral Angiography Research Articles

Pseudoaneurysms in a Penetrating Head and Neck Injury: a Case Series

An intricate challenge faced by neurosurgeons involves the management of cerebral vessel Pseudoaneurysms. A comprehensive understanding of their natural progression, typical symptoms, underlying pathophysiology, and the diverse spectrum of available treatment modalities is crucial. This research focuses on three atypical cases of pseudoaneurysms resulting from penetrating head and neck injuries, diagnosed through Cerebral Catheter Angiography. The initial case involved a 14-year-old female with a metal bar penetrating the right maxillary region. A Left Frontal Craniotomy was performed, entailing the trapping of the Left Internal Frontal Artery. The second case featured an 11-year-old female with a frontal bone penetration by marble from a slingshot, necessitating a Bicoronal craniectomy and clipping of the left pericallosal Artery Pseudoaneurysm. The third case, involving a gunshot penetrating the posterior aspect of the neck with a slug at C1 lamina, was managed conservatively. Cerebral Angiography emerged as a pivotal method for detecting vascular pathology. Radiographic images depicting the pseudoaneurysm and the implicated foreign object are presented. The research strongly advocates for Digital Subtraction Angiography as the Gold Standard Diagnostic tool for pseudoaneurysms in the context of penetrating head and neck injuries. This recommendation is grounded in the method's superior diagnostic capabilities and its potential to enhance the precision of clinical assessments and subsequent therapeutic interventions.

Safety Aspects and Procedural Characteristics of Ambulatory Diagnostic Cerebral Catheter Angiography.

Diagnostic cerebral catheter angiography is used to assess avariety of neurovascular pathologies especially in patients before and after endovascular neurointerventional treatment. In many centers diagnostic cerebral angiographies are performed with the patient staying for one night in the hospital because there are not yet sufficient data on the safety of ambulatory cerebral angiography. At the same time hospitals face agrowing demand to perform ambulatory medical procedures. A total of 426 ambulatory diagnostic cerebral angiographies were retrospectively analyzed. Technical details of the angiographies were analyzed to identify procedural risk factors. Out of 426 patients 14 (3.3%) had some form of complication, 3 developed minor transient neurological symptoms, 1 patient developed Quincke's edema probably as an adverse reaction to contrast agent, 1 patient had an asymptomatic carotid dissection and 1 had afall of unknown etiology. Of the 14complications 8 were puncture site complications with 1 re-bleeding, 1 dissection, and 6 minor complications, 421 punctures were femoral, 3 radial and 2 brachial. Out of 333 patients with magnetic resonance imaging (MRI) after angiography 21 showed focal diffusion-weighted imaging (DWI) lesions but none of these lesions were symptomatic. The rate of DWI lesions was significantly higher in selectively angiography territories than in other territories. The use of aSimmons 2catheter significantly increased the rate of DWI lesions (p = 0.047), whereas 3D rotational angiography did not (p = 0.55). The rate of DWI lesions per selectively accessed vessel was 4.6% with ahigher rate in the anterior than in the posterior circulation. Diagnostic cerebral catheter angiography can be safely performed in an ambulatory setting.

Incidence, Clinical Significance, and Longitudinal Signal Characteristics of Ischemic Lesions Related to Diagnostic Cerebral Catheter Angiography

PurposeCerebral DSA is a routine procedure with few complications. However, it is associated with presumably clinically inapparent lesions detectable on diffusion-weighted MRI imaging (DWI lesions). However, there are insufficient data regarding incidence, etiology, clinical relevance, and longitudinal development of these lesions. This study prospectively evaluated subjects undergoing elective diagnostic cerebral DSA for the occurrence of DWI lesions, potentially associated clinical symptoms and risk factors, and longitudinally monitored the lesions using state-of-the-art MRI.Materials and MethodsEighty-two subjects were examined by high-resolution MRI within 24 h after elective diagnostic DSA and lesion occurrence was qualitatively and quantitatively evaluated. Subjects’ neurological status was assessed before and after DSA by clinical neurological examination and a perceived deficit questionnaire. Patient-related risk factors and procedural DSA data were documented. Subjects with lesions received a follow-up MRI and were questioned for neurological deficits after a median of 5.1 months.ResultsAfter DSA, 23(28%) subjects had a total of 54 DWI lesions. Significantly associated risk factors were number of vessels probed, intervention time, age, arterial hypertension, visible calcified plaques, and less examiner experience. Twenty percent of baseline lesions converted to persistent FLAIR lesions at follow-up. After DSA, none of the subjects had a clinically apparent neurological deficit. Self-perceived deficits were nonsignificantly higher at follow-up.ConclusionCerebral DSA is associated with a considerable number of postinterventional lesions, some persisting as scars in brain tissue. Presumably because of the small lesion size and inconsistent location, no clinically apparent neurological deficits have been observed. However, subtle self-perceived changes may occur. Therefore, special attention is needed to minimize avoidable risk factors.

Abstract Number ‐ 250: Case Series of Moyamoya Patients Diagnosed on Hyperacute Imaging

Introduction Moyamoya disease is the idiopathic bilateral progressive stenosis of the anterior circulation arteries at the skull base, followed by the compensatory formation and proliferation of collateral small vessel arteries typically in the lenticulostriate region. The clinical diagnosis is made by neurovascular imaging with digital subtraction angiography being the gold standard of diagnosis. The term moyamoya syndrome is used when the formation of collateral arteries occur after unilateral vasculopathy or if the progressive stenosis occurs in the setting of known associated conditions such as sickle cell disease or prior cranial radiation treatment. For patients who have undiagnosed moyamoya syndrome, stroke symptoms may be the first presentation of the underlying disease. Methods We present a case series of 15 patients who arrived to our tertiary care hospital from December 2014 to July 2022. Results The majority of the patients were women with the average age of 43 years old. Patients were admitted with NIHSS ranging from 0 to 14, and two patients presented with signs suggestive of MCA syndrome. Including major ischemic stroke risk factors, five patients also had differentials of antiphospholipid antibody syndrome, connective tissue disorder, vasculitis, and congenital rubella as possible underlying conditions promoting the vasculopathy. Morbidity was high for moyamoya patients, with an average modified Rankin scale of 2 at discharge. Eleven patients had unknown moyamoya history at time of arrival and were identified based on hyperacute diagnostic CT angiography during stroke evaluation. Five patients were initially diagnosed as large vessel occlusion on CT angiography. Given the speed at which IV thrombolysis and mechanical thrombectomy decisions are made, patients with moyamoya vasculopathy require rapid and accurate interpretation of CT findings that distinguish them from standard large vessel occlusion patients and prevent the potentially catastrophic consequences of inappropriate treatment. Conclusions The pathophysiology leading to moyamoya disease is not well understood, but the stenosis process of major arteries is thought to be secondary to irregular hyperplasia of the tunica media, followed by compensatory growth of small collateral vessels. This collateralization leads to micro‐aneurysm formation in the small perforator branches. Moyamoya patients are at an increased risk of hemorrhage, representing a contraindication to IV thrombolysis, and, if mechanical thrombectomy is attempted, risk of possible large vessel rupture. In our case series, the 15 patients did not receive IV thrombolysis or mechanical thrombectomy based on appropriate diagnosis of moyamoya vasculopathy at time of emergency CT angiography, subsequently confirmed by elective, catheter cerebral angiography.

External carotid artery to ophthalmic artery flow associated with internal carotid artery stenosis

ABSTRACT Purpose One of the most devastating complications of facial filler injection is sudden ischemic blindness. However, its mechanisms and predisposing factors are poorly understood. The purpose of this study was to investigate the prevalence of external carotid artery (ECA) to ophthalmic artery (OA) anterograde flow in patients with internal carotid artery (ICA) stenosis and in a control population without carotid disease. Methods In this cross-sectional cohort study, two groups of patients who underwent catheter cerebral angiography over a 5-year period were identified: patients with symptomatic ICA stenosis and a control group of patients with refractory epistaxis undergoing embolization. Angiograms were reviewed by an interventional neuroradiologist. The primary outcome measure was the presence of ECA to OA flow, defined as choroidal blush before filling of the circle of Willis. Secondary outcome measures included the percentage and location of ICA stenosis and ECA anastomotic branches involved. Results The study included 149 patients with ICA stenosis and 69 control patients. ECA to OA flow was more prevalent in patients with ICA stenosis (34.9%) compared to controls (2.9%) (p < .001). Logistic regression demonstrated that for each 10% increase in ICA stenosis over 70%, there was 2.8 times increased risk of ECA to OA flow (p < .001). Conclusions ECA to ICA anterograde flow can be demonstrated in approximately 3% of control patients and in over 1/3 of patients with symptomatic carotid stenosis. This provides a plausible pathway for small filler particles to pass with blood flow from the facial to the ophthalmic circulation.

Cervical carotid artery vasospasm during cerebral angiography

Background: Vasospasm occurs commonly in the intracranial arteries as a complication of subarachnoid haemorrhage. On the other hand, extracranial Internal carotid artery (ICA) vasospasm is scarce, and it may occur due to mechanical manipulation during cerebral angiography. We report a case of cervical carotid artery vasospasm during diagnostic cerebral angiography, which caused anterior cerebral artery territory hypoperfusion, to discuss potential risk factors. Case description: For a 22-year-old female with a ten-year history of epilepsy on multiple drugs, brain magnetic resonance imaging (MRI) showed frontal periventricular developmental venous anomaly. Diagnostic catheter cerebral angiography was used to better identify the vascular abnormality. In the procedure, extra steps were performed, including instruments being sterilized with CIDEX® OPA Solution (phthalaldehyde as the active ingredient), the reuse of the set including the catheters more than twice or triple times, and cold temperature of normal saline that was used in the flushing procedure. Under conscious sedation, the procedure went uneventful until the catheterization of the left carotid artery was performed, where severe vasospasm was noticed in the extracranial ICA, followed by cessation of flow in the ipsilateral ACA. Pulling the catheter to a more proximal location in the extracranial ICA was performed to alleviate the vasospasm. It took twelve minutes for the circulation to be restored, and that was under continuous irrigation and flushing. The patient did not develop any symptoms throughout the procedure or post-procedural course. Conclusion: Chemical irritation from the sterilizing agent and reuse of the catheters could cause extracranial ICA vasospasm.

Trends in Utilization of Temporary and Permanent Cerebrospinal Fluid Diversion and Catheter Cerebral Angiography for Patients with Aneurysmal Subarachnoid Hemorrhage in the United States

We sought to analyze the rate of utilization of methods of cerebrospinal fluid diversion over time in a nationally representative cohort of patients admitted with aneurysmal subarachnoid hemorrhage (aSAH). The Nationwide Inpatient Sample was queried for patients admitted with aSAH from 2006 to 2018. Patients who received external ventricular drainage (EVD), lumbar drainage, ventriculoperitoneal shunt (VPS), and cerebral angiography were then identified. A Cochrane-Armitage test was conducted to assess the linear trend of proportions of EVD, lumbar drains, VPS, and mean cerebral angiograms per admission. Four regression analyses were conducted to infer the association of baseline variables to EVD, lumbar drain, VPS, and mean number of cerebral angiographies. A total of 133,567 admissions were identified from 2006-2018 involving aSAH. Of these, 41.82% received EVD, 6.22% received lumbar drainage, 10.58% received VPS, and 75.03% had cerebral angiograms. There was an average upward trend of 1.57% in annual EVD utilization, downward trend of -0.28% in utilization of lumbar drainage, no changes in VPS utilization, and an upward trend of 0.04 angiograms per year (P < 0.001). There was a higher proportion of Black patients treated with EVD and VPS in both urban teaching hospitals and large hospitals. Our results show the temporal trends in utilization of temporary and permanent methods of cerebrospinal fluid diversion and catheter cerebral angiography among patients with aSAH in the United States. The underutilization of VPS following EVD and the differences in EVD and VPS utilization depending on race and hospital size deserve further exploration.

Abstract No. 564 Trends in utilization of catheter cerebral angiography for patients with aneurysmal subarachnoid hemorrhage in the United States

To analyze the rate of utilization of catheter cerebral angiography over time in a nationally representative cohort of patients admitted with from aneurysmal subarachnoid hemorrhage (aSAH)

Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study.

Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14-0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.

Intra-Aortic Time-Resolved Whole-Brain CT Angiographic Evaluation of an Arteriovenous Malformation

This is the first documented case of time-resolved (4D) intra-aortic whole-brain CTA reported in the literature for a newly diagnosed AVM. This was performed simultaneously as part of a catheter cerebral angiography with both planar and CT imaging, in the hybrid interventional radiology/CT suite. The described technique is unique in that intra-aortic injection of diluted contrast was utilized to obtain the time-resolved CTA image of the whole brain.

CLINICAL AND RADIOLOGICAL EVALUATION OF PATIENTS WITH SUBARACHNOID HAEMORRHAGE SUBJECTED TO DIGITAL SUBTRACTION ANGIOGRAPHY IN AL-HUSSEIN NEURO-INTERVENTION UNIT

Background: Subarachnoid hemorrhage (SAH) refers to bleeding that occurs primarily within the subarachnoid space, in between cases of spontaneous SAH and rupture of an intracranial saccular aneurysm accounts for approximately 85%. Objectives: The aim of this study was to assess clinical presentation, risk factors and the etiology of subarachnoid hemorrhage in a sample of Egyptian patients, and also assess the outcome of endovascular management and complications. Patients and Methods: The study was carried out on patients with SAH who were subjected to endovascular neuro-intervention unit in AL-Hussein University Hospital, including patients with SAH retrospectively from 2006 to 2018, and the newly diagnosed patients during 2019. Results: During the period from May 2006 to May 2019, 560 patients with SAH has been admitted. 136 patients (24.2%) were excluded from the study as they were critically ill. Their Hunt and Hess score were 4 to 5. Also, another 51 has been excluded due to missed files or discharge against medical advice. The remaining 373 patients. 145 patients were angiographically free, Patients with aneurysm were 228 patients, 77 patients died before therapeutic endovascular treatment as they delayed due to financial troubles, The remaining patients were 151, The most common type of aneurysm between those patients was anterior communicating aneurysm (27.8%), then MCA aneurysm (17.8%), posterior communicating artery aneurysm (13.9%), para-ophthalmic artery aneurysm (6.6 %), basilar artery aneurysm (5.9%), posterior inferior cerebellar artery aneurysm (6.4%), supraclinoid carotid artery aneurysm (3.1%), peri callossal artery aneurysm (3.3%), T carotid artery aneurysm (7.2%), superior cerebellar artery aneurysm (1.9%), inferior cerebellar artery aneurysm (2.6%) and multiple aneurysms (6.6%). The complications of endovascular treatment in studied patients occurred in 13 patients (3.4%) in the form of aneurysmal rupture, coil displacement, hydrocephalus and vessel rupture. Conclusion: Cerebral catheter angiography is a safe, feasible and efficacious procedure. The new technique in the endovascular management of the cerebral aneurysm as balloon or stent assisted technique and flow diverter stent is greatly reducing the complication rate and making the outcome is very promising.

Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?

ObjectiveWhile the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. MethodsPatients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. ResultsIn-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p =0.032). Cerebral angiography after SAH was performed on 88 patients ≤3 hours, 74 patients between 3–6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ≤3 hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. ConclusionDespite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.

Neurointerventional Procedural Complications in a Growing Canadian Regional Stroke Center: Single Hospital Experience Analysis in the Context of Recommended Case Volumes

Evidence continues to emerge regarding the inverse relationship between high neurointerventional case volume and complication rates, leading several medical/surgical societies to recommend minimum volumes for specific procedures. Recent data suggest few centers are meeting these requirements. We report a single center's neurointerventional complication rates with associated case volumes, along with a review of the literature. A retrospective cohort review of all consecutive patients undergoing diagnostic catheter cerebral angiography and/or neurointerventional procedures between January 1, 2013, and March 1, 2018, was undertaken. No diagnostic or interventional procedures were excluded. All major and minor complications were recorded. A total of 1000 procedures (463 diagnostic cerebral angiograms and 537 neurointerventional procedures) were completed. Of the neurointerventional procedures, 216 (40%) were endovascular thrombectomy, 170 (32%) were aneurysmal embolization, and 48 (9%) were carotid stenting. The mean and median age was 60 years. There were 460 women and 540 men. The total number of major complications for diagnostic angiography, endovascular thrombectomy, ruptured aneurysm embolization, unruptured aneurysm embolization, and carotid artery stenting were 4 (0.9%), 4 (1.9%), 10 (11%), 4 (5.4%), and 3 (6.3%), respectively. We provided a single-center experience of the relationship between neurointerventional procedural case volume and complication rates in the growth phase of our center's establishment. We demonstrated that as our center was being developed, specific procedural staffing measures allowed proficiency maintenance, acquisition of new techniques, and complication avoidance, whereas specific case volumes crossed the suggested thresholds as defined in the literature.

SA115THE UBC MAGERS STUDY OF SEVERELY TREATMENT-RESISTANT PSYCHOSIS: CHROMOSOMAL MICROARRAY FINDINGS IN THE FIRST 25 CASES

Neurologic diagnostic procedures are usually not used for preliminary screening of patients, except in emergency situations. This may be when a complete neurological evaluation is justified to rule out severe neurological disease, such as subarachnoid hemorrhage or stroke. Testing is guided by the evidence revealed during patient history and physical examination. Neurologic diagnostic procedures include, but are not limited to lumbar puncture, computed tomography, magnetic resonance imaging, encephalography, cerebral catheter angiography, duplex Doppler ultrasonography, myelography, electroencephalography, and electromyography. Historically, neurologists believed that diagnosis almost always could be made by localizing a lesion, using patient history and examination. Authors still believe that localization of the lesion through examination and history is the most important step toward arriving on a correct diagnosis. With the advent of technology, however, neurologists are now more dependent on various diagnostic tests. New imagining techniques proved that localization through the neurological exam and history was not always accurate.

Prediction of Delayed Cerebral Ischemia with Cerebral Angiography: A Meta-Analysis.

Cerebral catheter angiography is the gold standard for diagnosing cerebral artery vasospasm (vasospasm) in aneurysmal subarachnoid hemorrhage (SAH). We have previously published a meta-analysis of prediction of delayed cerebral ischemia (DCI) from transcranial Doppler (TCD) evidence of vasospasm. Analogous data relating to prediction of DCI have not been previously collated for cerebral angiography nor reconciled against TCD. We searched PUBMED, the Cochrane database, and clinicaltrials.gov for studies that used cerebral angiography for diagnosis of vasospasm and evaluated DCI in patients with SAH. We performed a random-effects meta-analysis of prediction of DCI with cerebral angiography, reconciling its accuracy against that of TCD. We also report quality of evidence for the value of cerebral angiography and TCD in SAH based on pooled data from our meta-analyses. A total of 15 studies (n = 5463) were included in the meta-analysis. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of cerebral angiography for prediction of DCI are 57, 68, 32, and 90%. These metrics for TCD, based on our previous meta-analysis, are 90, 71, 57, and 92%. We report that test accuracy estimates are "moderate" for TCD and "low" for angiography based on pooled data from our meta-analyses. TCD evidence of vasospasm is a better predictor of DCI than angiographic vasospasm. Future comparative effectiveness studies can better define the value of these diagnostic tools in patients with SAH.

Diagnosis of Cerebral Aneurysm Via Magnetic Resonance Angiography Screening: Emphasis on Legal Responsibility Increases False Positive Rate.

PurposeFalse positive diagnoses of cerebral aneurysm via magnetic resonance angiography (MRA) screening may increase unnecessary cerebral catheter angiography. The purpose of this study was to investigate the effects of medical liability on medical decision-making during radiologic interpretation.Materials and MethodsWe included 56 consecutive patients who were referred with suspected aneurysm based on MRA or computed tomography angiography (CTA) and showed no aneurysm on subsequent digital subtraction angiography (DSA). MRA and CTA were reviewed twice by two neuroradiology fellows who were blind as to whether the suspected lesions were true aneurysms or not. The second review was repeated after proposing that their decision was subject to legal liability and they would be responsible for medico-legal problems related to their diagnoses. Diagnostic differences based on each review were analyzed, focusing on changes in false positive diagnosis rates.ResultsA total of 63 suspected aneurysmal lesions detected via MRA or CTA were found to be negative based on DSA. At first review, 32 lesions were diagnosed as true aneurysms by observer 1 and 27 by observer 2, corresponding to false positive rates of 51% and 43% respectively. At the second review, 39 lesions (62%) were diagnosed by observer 1, and 30 (48%) by observer 2. Thus, there was an overall increase in false positive aneurysm diagnosis of 11% for observer 1 and 5% for observer 2, after emphasizing their responsibilities in the context of medical litigation.ConclusionConcerns about medical liability could result in increased false positive diagnoses of cerebral aneurysms via MRA screening. Whether repeated follow-up of the suspected lesion or catheter angiographic confirmation is better with regard to long-term patient outcomes requires further study.

Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up

OBJECTIVE Flow diversion requires neointimal stent overgrowth to deliver aneurysm occlusion. The existing literature on aneurysm occlusion is limited by heterogeneous follow-up, variable antiplatelet regimens, noninvasive imaging modalities, and nonstandard occlusion assessment. Using a large, single-center cohort with low attrition and standardized antiplatelet tapering, the authors evaluated outcomes after flow diversion of anterior circulation aneurysms to identify predictors of occlusion and aneurysm persistence. METHODS Data from a prospective, IRB-approved database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion with the Pipeline embolization device (PED) at the authors' institution. Follow-up consisted of catheter cerebral angiography at 6 and 12 months postembolization. Clopidogrel was discontinued at 6 months and aspirin was reduced to 81 mg daily at 12 months. Occlusion was graded as complete, trace filling, entry remnant, or aneurysm filling. Multivariate logistic regression was performed to identify predictors of aneurysm persistence. RESULTS Follow-up catheter angiography studies were available for 445 (91%) of 491 PED procedures performed for anterior circulation aneurysms between August 2011 and August 2016. Three hundred eighty-seven patients accounted for these 445 lesions with follow-up angiography. The population was 84% female; mean age was 56 years and mean aneurysm size was 6.6 mm. Aneurysms arose from the internal carotid artery (83%), anterior cerebral artery (13%), and middle cerebral artery (4%). Morphology was saccular in 90% of the lesions, and 18% of the aneurysms has been previously treated. Overall, complete occlusion was achieved in 82% of cases at a mean follow-up of 14 months. Complete occlusion was achieved in 72%, 78%, and 87% at 6, 12, and 24 months, respectively. At 12 months, adjunctive coiling predicted occlusion (OR 0.260, p = 0.036), while male sex (OR 2.923, p = 0.032), aneurysm size (OR 3.584, p = 0.011), and incorporation of a branch vessel (OR 2.206, p = 0.035) predicted persistence. Notable variables that did not predict aneurysm occlusion were prior treatments, vessel of origin, fusiform morphology, and number of devices used. CONCLUSIONS This is the largest single-institution study showing high rates of anterior circulation aneurysm occlusion after Pipeline embolization. Predictors of persistence after flow diversion included increasing aneurysm size and incorporated branch vessel, whereas adjunctive coiling predicted occlusion.

Transradial cerebral angiography: techniques and outcomes

BackgroundDespite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based...

The risk assessment of antiplatelet medications in angiogram-negative subarachnoid hemorrhage

Objective The influence of antiplatelet medications on prognosis after non-aneurysmal subarachnoid hemorrhage(SAH) is unknown.This study aimed to evaluate the risk of antiplatelet mdications in developing SAH. Methods 420 patients who underwent catheter cerebral angiography after presenting with nontraumatic SAH were included.Outcomes were assessed by using the modified Rankin scale. Results A total of 420 patients underwent catheter angiography for evaluation of SAH.Of these, 63 cases (15%) were angiogram-negative.The fraction of patients presenting with angiogram-negative SAH as well as the frequency of antiplatelet use among these patients significantly increased during the study period.Antiplatelet use was more commonly associated with angiogram-negative SAH(18/63, 28.6%) than with angiogram-positive SAH(39/357, 11%; P=0.001). At 14 days after presentation, poor outcome was significantly more frequent among patients who took antiplatelet agents(20/63, 31.7%) than among those who did not(12/63, 20%; P=0.017). Conclusion Antiplatelet medication use is associated with poor early, but not late, outcomes after angiogram-negative SAH.More studies are needed to confirm this association. Key words: Platelet aggregation inhibitors; Negative reactions; Cerebral angiography; Subarachnoid hemorrhage

Sneddon's syndrome: it is all in the ectoderm

A 51-year-old man gave a 2-year history of worsening mobility, cognitive decline and headaches. He had a history of thromboembolic stroke, recurrent transient ischaemic attacks and a spontaneous intraventricular haemorrhage....