Cavernous Artery Research Articles

MP-07.10 3D Cavernosography and Virtual Cavernoscopy With Low Pressure Dynamic Infusion Cavernosometry and Cavernosography

Diagnostic accuracy of dynamic infusion cavernosometry and cavernosography (DICC) was improved remarkably with 3D image technology. Furthermore, adoption of virtual cavernoscopy enabled visualization of the cavernous artery. To date, diagnosis of DICC has been made under 90 mmHg of intracavernous pressure, which is similar conditions of complete erection. We have studied the possibility of lowering this pressure to 45 mmHg.

MP-07.09 The Study of Cavernous Arteries in Virtual Cavernoscopy

MP-07.09 The Study of Cavernous Arteries in Virtual Cavernoscopy

Oral Tadalafil Administration Plus Low Dose Vasodilator Injection: A Novel Approach to Erection Induction for Penile Color Duplex Ultrasound

We prospectively compared clinical response and penile color duplex ultrasound results of oral tadalafil 20 mg plus low dose intracavernous injection of vasoactive agents with those of intracavernous injection and oral tadalafil 20 mg alone. We also observed the best approach to facilitate penile color duplex ultrasound and that most preferred by patients. All 56 patients with erectile dysfunction underwent penile color duplex ultrasound 3 times at an interval of at least 1 week using different pharmacological induction methods, including tadalafil mode (20 mg tadalafil), intracavernous injection mode (30 to 60 mg papaverine) and mixed mode (15 mg papaverine plus 20 mg tadalafil). Ultrasound parameters included peak systolic and end diastolic velocity, resistance index and acceleration time. Clinical response was assessed by the erection hardness score. Patient preference was determined when all tests were finished. For penile color duplex ultrasound parameters no significant difference was observed between intracavernous injection and mixed modes. However, for tadalafil mode peak systolic velocity of the 2 cavernous arteries measured 15 minutes after induction were significantly lower than for intracavernous injection and mixed modes. Also, acceleration time of the right cavernous artery measured 5 minutes after induction and left cavernous artery measured 15 minutes after induction in tadalafil mode were significantly shorter than those in intracavernous injection and mixed modes. No severe side effect occurred in tadalafil and mixed modes but 2 patients experienced priapism in intracavernous injection mode. Of the patients 55.4% preferred tadalafil mode, an incidence significantly higher than intracavernous injection (16.1%) and mixed (28.5%) modes. Oral tadalafil plus low dose vasodilator led to a significantly better clinical response than high dose vasodilator. Penile color duplex ultrasound parameters showed no difference between the 2 modes. Thus, this mixed mode emerges as a possible alternative to high dose vasodilator injection.

Dosimetric Feasibility of Prostate Permanent-Seed Implant Brachytherapy Plans Using Non-Parallel Penile-Bulb-Avoiding Needle Geometries

Purpose: Physical damage to the cavernous arteries running along the side of the penile bulb has been shown to cause erectile dysfunction. It is reasonable to hypothesize that trauma from needle puncture to the critical structures near the penile bulb (CSNB) (nerves, vessels, and penile bulb) during prostate permanent-seed implant (PPI) brachytherapy may be deleterious to erectile function. We determine the clinical feasibility of alternative needle geometries that completely avoid puncturing the CSNB.

Large Aneurysm in a Nonbifurcating Cervical Carotid Artery: An Aneurysm Associated With a Rare Anomaly Treated With Radial Artery Graft Bypass: Case Report

A nonbifurcating cervical carotid artery is an extremely rare type of carotid artery anomaly. We present a patient with a nonbifurcating cervical carotid artery and a large aneurysm of the cavernous internal carotid artery (ICA). The patient was successfully treated with combined microsurgical and endovascular techniques. We describe this case with reference to the relevant literature. A 66-year-old woman with progressive left external ocular movement dysfunction was found to have a large left cavernous ICA aneurysm. Serial magnetic resonance angiography revealed progressive growth of the lesion. In addition, conventional angiography showed a nonbifurcating cervical carotid artery and a persistent primitive trigeminal artery. The aneurysm was found unsuitable for direct surgery because of its size and location and for endovascular intervention because of extreme tortuosity of both carotid and right vertebral arteries. Surgery was performed in 2 stages. First, we performed an extracranial-intracranial high-flow bypass using radial artery graft, followed by proximal occlusion of the carotid artery. As the second stage, the patient underwent intravascular parent artery occlusion via the radial artery graft bypass to approach the intracranial carotid artery. The carotid artery was successfully coil embolized, and the aneurysm was undetectable on a postprocedure angiogram. Serial follow-up magnetic resonance imaging revealed thrombosis of the aneurysm. We report a rare case that involves the novel use of the radial artery graft bypass as an approach for parent vessel occlusion.

Virtual cavernoscopy: a novel diagnostic tool for use in the corpus cavernosal lumen in patients with erectile dysfunction

• To evaluate virtual cavernoscopy as a diagnostic tool in erectile dysfunction. • Forty patients who visited our hospital for investigation of erectile dysfunction underwent cavernosography using three-dimensional (3D)-computed tomography (CT). • Virtual cavernoscopic images were reconstructed from 3D-CT data. • Virtual cavernoscopic images were obtained from all patients. • Virtual cavernoscopy visualized the corpus cavernosal lumen surrounded by the tunica albuginea, the septum of the cavernosum, the outlets of the veins, and cavernous arteries. • The visualization of each structure depended on the window level (WL). At WL 400, the virtual cavernoscopy visualized only a fibrous structure. At this WL, the internal view of the corpus cavernosum was expressed as a hollow space. At WL 1600, the virtual cavernoscopy visualized the cavernous artery as a filling defect. • Out of 80 lumens in the 40 subjects, arteries in 14 lumens were detected by both virtual cavernoscopy and CT angiography, while arteries in 50 lumens were detected only by virtual cavernoscopy. Arteries in two lumens could not be visualized by either method and those in 14 lumens were visualized only by CT angiography. • In visualizing the artery, conventional imaging techniques depend on blood flow, whereas using virtual cavernoscopy an artery can be visualized independently of blood flow. Virtual cavernoscopy is unique in this regard and we therefore believe that this new imaging technology will contribute to better ED practice.

Original immunophenotype of blood endothelial progenitor cells and microparticles in patients with isolated arterial erectile dysfunction and late onset hypogonadism: effects of androgen replacement therapy

Objective. Blood endothelial progenitor cells (EPCs) and endothelial microparticles (EMPs) have been proposed as markers of endothelial dysfunction. Aim of this study was to evaluate an original immunophenotype of EPCs and EMPs in patients with isolated arterial erectile dysfunction (ED) and late onset hypogonadism (LOH) before and after androgen replacement therapy.Materials and methods. Fifty patients (50–64 years) with ED and LOH were selected. EPC (CD45neg/CD34pos/CD144pos) and EMP (CD45neg/CD34neg/CD144pos) blood concentrations were evaluated by flow cytometry. Thirty patients received androgen replacement therapy (Tostrex® ProStrakan) for 6 months (group A), other 20 patients not received androgen therapy for the contraindications in their clinical history (group B).Results. After 6 months, group B showed IIEF-5 score, peak systolic velocity and acceleration time significantly worse than group A; in addition EPCs and EMPs were significantly higher in group B compared to group A.Conclusions. Patients with isolated arterial ED and LOH not treated with androgen therapy showed worst vascular parameters measured by penile Doppler and higher EPCs and EMPs compared to treated hypogonadal patients, hence, LOH appears to be an additional vascular risk factor, and these markers may be considered as predictors of cavernous artery disease. Finally, androgen therapy improves endothelial dysfunction.

New Immunophenotype of Blood Endothelial Progenitor Cells and Endothelial Microparticles in Patients With Arterial Erectile Dysfunction and Late-Onset Hypogonadism

Blood endothelial progenitor cells (EPC) and microparticles (EMP) have been proposed as markers of endothelial dysfunction. The aim of this study was to evaluate a new immunophenotype of EPCs and EMPs in patients with arterial erectile dysfunction (ED) and late-onset hypogonadism (LOH). Fifty patients (58.2 ± 0.7 years) with ED and LOH were enrolled in this study. Their EPC and EMP concentrations were compared with those of 20 patients with arterial ED alone (61.2 ± 1.2 years) and of 20 healthy men (controls; 61.4 ± 1.2 years). EPC (CD45(neg)/CD34(pos)/CD144(pos)) and EMP (CD45(neg)/CD144(pos)/annexin V(pos)) blood concentrations were evaluated by flow cytometry. Patients with ED and LOH or ED alone had significantly higher blood pressure, triglycerides, homeostasis model assessment index of insulin resistance, cavernous artery acceleration time, and intima-media thickness than controls, whereas International Index of Erectile Function score, high-density lipoprotein cholesterol, and cavernous artery peak systolic velocity and resistance index were lower than those of controls. Both EPCs and EMPs were significantly higher in patients with ED and LOH compared with patients with ED alone or controls. Patients with ED alone had EPCs and EMPs significantly higher than controls. In conclusion, patients with ED and LOH showed worse metabolic parameters and cavernous artery parameters, measured by dynamic penile echo color Doppler, and higher EPCs and EMPs compared with patients with ED alone. This suggests that LOH is an additional vascular risk factor and that EPCs and EMPs may be considered predictors of endothelial dysfunction in patients with ED and LOH.

Midline Filum of the Sellar Dura: A Useful Landmark During Endoscopic Transsphenoidal Pituitary Surgery

During endoscopic transsphenoidal pituitary surgery, identification and constant awareness of the midline is imperative to prevent injury to critical lateral structures, such as the internal carotid arteries. To describe the relevance of a midline filum of the sellar dura which, when present, can serve as a useful intraoperative anatomic marker. Intraoperative video recordings of twenty patients undergoing endoscopic transsphenoidal surgery were retrospectively reviewed to assess for the presence and location of a midline dural filum or apparent central dural vascular structure. Prospective intraoperative data were gathered on an additional 16 patients. A midline dural filum was identified in 18 of 36 patients (50%) undergoing endoscopic transsphenoidal surgery. This structure was identified on the midline in all cases, as confirmed by intraoperative neuronavigation and comparison with the vomer. The midline dural filum was identified as a strand-like dural extension (13 patients) or as a small vascular dural structure usually exhibiting low pressure venous bleeding (5 patients). Samples of the midline dural filum were obtained from 2 patients for histopathological analysis, which demonstrated dense collagenous connective tissue without evidence of vessel wall or ductal epithelium. In addition to anatomic structures such as the vomer and midline sphenoid sinus septations, a midline dural filum serves as a useful marker during the sellar phase of endoscopic transsphenoidal surgery. Along with intraoperative neuronavigation and Doppler ultrasonography of the cavernous carotid arteries, identification of this structure may further aid in safeguarding against injury to critical paramedian structures.

Erectile dysfunction of sclerodermic patients correlates with digital vascular damage

Background The prevalence of erectile dysfunction (ED) in men with systemic sclerosis (SSc) can be considered a manifestation of endothelium damage. Aim of the study is to investigate ED in SSc patients by color Doppler ultrasound examination and to correlate it with disease severity and digital vascular damage. Methods In 20 males SSc patients blood flow velocity in the cavernous artery was determined with Duplex ultrasonography. Naifold videocapillaroscopy, Sexual Health Inventory for Men (SHIM) and Medsger Disease Severity Scale (DSS) were performed. Arteriogenic ED was defined by the presence of a reduced peak systolic velocity (PSVs), while diastolic velocity (EDV) and the resistive index (RI) were estimated to evaluate venocclusive dysfunction. SSc patients are classified by capillaroscopic pattern and vascular domain of DSS into two groups: low vascular damage (early or active capillaroscopic pattern and score of vascular domain of DSS ≤ 2) and high vascular damage (late capillaroscopic pattern and score of vascular domain of DSS ≥ 3). Results In all SSc patients a reduction of SHIM is present (mean 13.5 ± 6.3). Patients with less vascular damage have a significantly ( p < 0.001) higher score of SHIM than patients with greater vascular damage (19.2 ± 2.4 vs 7.9 ± 2.7). No significant difference ( p > 0.5) between the two groups of vascular damage was found in PSVs. Venocclusive dysfunction was present only ( p < 0.001) in the group with high vascular damage. Conclusion We can assert that there is a relationship between SSc vascular digital damage and ED.

Cavernous sinus artery - sylvian - Labbé venous fistulae associated with large venous aneurysm: case report and review literatures

Objective To observe the clinical characteristics of the cavernous sinus artery - sylvian -venous remained with surgical resection of venous aneurysm. The literatures of patients with the Cognard Ⅳ DAVF were reviewed. Results There were no neurological deficits in this patient after microsurgical treatment. The digital subtractions angiogram showed that the fistula was completely occluded and venous aneurysm disappeared. The recurrence of DAVF was not found during the five - year follow - up. Among the review of literatures, there were 66% patients with intracranial hemorrhage;the fistulas were occluded completely and permanently through the selective disconnection of venous drainage;in 13 patients with venous aneurysm, 9 patients of them were treated though the surgical resection or coagulation of venous aneurysms. Conclusions Patients with DAVF associated with retrograde cortical venous drainages,especially with venous ectasia or aneurysms, have more often aggressive course. Selective disconnection of venous drainage and resection of venous aneurysm may provide an effective treatment option of this subtype of DAVF. Key words: Arterovenous fistula; Venous aneurysm; Cavernous sinus; Labbe vein; Microsurgery

Experimental model of human corpus cavernosum smooth muscle relaxation

To describe a technique for en bloc harvesting of the corpus cavernosum, cavernous artery and urethra from transplant organ donors and contraction-relaxation experiments with corpus cavernosum smooth muscle. The corpus cavernosum was dissected to the point of attachment with the crus penis. A 3 cm segment (corpus cavernosum and urethra) was isolated and placed in ice-cold sterile transportation buffer. Under magnification, the cavernous artery was dissected. Thus, 2 cm fragments of cavernous artery and corpus cavernosum were obtained. Strips measuring 3 x 3 x 8 mm(3) were then mounted vertically in an isolated organ bath device. Contractions were measured isometrically with a Narco-Biosystems force displacement transducer (model F-60, Narco-Biosystems, Houston, TX, USA) and recorded on a 4-channel Narco-Biosystems desk model polygraph. Phenylephrine (1 microM) was used to induce tonic contractions in the corpus cavernosum (3-5 g tension) and cavernous artery (0.5-1 g tension) until reaching a plateau. After precontraction, smooth muscle relaxants were used to produce relaxation-response curves (10(-12) M to 10(-4) M). Sodium nitroprusside was used as a relaxation control. The harvesting technique and the smooth muscle contraction-relaxation model described in this study were shown to be useful instruments in the search for new drugs for the treatment of human erectile dysfunction.

Balloon test occlusion with hypotensive challenge for main trunk occlusion of internal carotid artery aneurysms and pseudoaneurysms

Background. Balloon test occlusion of carotid artery is a useful procedure in managing patients with internal carotid aneurysms and psuedoaneurysms. Previous studies using intravenous sodium nitroprusside for hypotensive challenge yielded false-negative results for haemodynamic ischaemia, highlighting the difference between pharmacological and compensatory vasodilatory responses. We reviewed our management result of a combined approach of clinical assessment and angiographic assessment of venous drainage using intravenous labetalol for hypotensive challenge.Methods. A retrospective review of all balloon test occlusions carried in a single neurosurgical institute between August 1996 and August 2009 was carried out. Patients with internal carotid artery aneurysms and pseudoaneurysms were reviewed accordingly.Results. The diagnosis at the time of treatment included radiotherapy-induced internal carotid artery pseudoaneurysms in nasopharyngeal carcinoma patients (11/23, 48%), cavernous internal carotid artery giant aneurysm (6/23, 26%) and ophthalmic segment internal carotid artery giant aneurysm (4/23, 17%). Nineteen (79%) patients passed the balloon test occlusion. In the cohort of patients that passed balloon test occlusion and underwent main trunk occlusion, there were no (0/20, 0%) permanent and no (0, 0%) transient neurological complications related to a subsequent parent artery occlusion.Conclusions. A combined approach of clinical assessment and angiographic assessment of venous drainage, using intravenous labetalol for hypotensive challenge, is effective in screening out patients who were at a risk for ischaemia after internal carotid artery occlusion and can serve as a guideline for the selection of patients requiring extracranial–intracranial bypass.

A double‐blind placebo‐controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie’s disease

To analyse the safety and efficacy of pentoxifylline sustained-release (PTX-SR) treatment in patients with early chronic Peyronie's disease (PD). In all, 228 patients with a mean (sd) age of 51 (9) years who had early chronic PD were randomized to receive 400 mg PTX-SR (Apo-Pentoxifylline, Apotex Inc., Toronto, Canada) twice daily (group 1, 114) or similar regimen of placebo (group 2, 114) for 6 months. A medical history was taken and the men had a complete physical examination. The following variables were assessed before and after therapy: penile curvature and penile artery spectral traces (end-diastolic velocity, EDV, peak systolic velocity, PSV, and resistivity index, RI, of the right and left cavernous arteries assessed with dynamic penile duplex ultrasonography), plaque characteristics (assessed by penile X-ray and penile ultrasonography), pain (assessed by visual analogue scale), erectile function (assessed by the International Index of Erectile Function, IIEF questionnaire), treatment satisfaction (assessed by Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire), and side-effects. Patient perception of penile curvature and plaque size, and mean weekly intercourse attempts were also assessed. Overall, 36.9% of patients who received PTX-SR reported a positive response, vs only 4.5% in the placebo group. Of patients in PTX-SR group, 12 (11%) had disease progression, vs 46 (42%) in placebo group (P = 0.01). Improvement in penile curvature (P = 0.01), and plaque volume (P = 0.001) was significantly greater in patients treated with PTX-SR than placebo. The increase in IIEF total score was significantly higher in the PTX-SR group (P = 0.02). Mean PSV changes after therapy compared to baseline were statistically significant between PTX-SR (right, +11.4%, left, +11.7%) and placebo-treated (+0.2% and -4.2%, respectively) patients (both P = 0.04). PTX-R was moderately effective in reducing penile curvature and plaque volume in patients with early chronic PD. Further studies with different treatment regimens are needed to better elucidate the beneficial effects of PTX-SR in PD.

Expression of Cyclic AMP-dependent Protein Kinase Isoforms in Human Cavernous Arteries: Functional Significance and Relation to Phosphodiesterase Type 4

The cyclic adenosine monophosphate-dependent protein kinase (cAK) is considered a key protein in the control of smooth muscle tone in the cardiovascular system. There is evidence that erectile dysfunction might be linked to systemic vascular disorders and arterial insufficiency, subsequently resulting in structural changes in the penile tissue. The expression and significance of cAK in human cavernous arteries (HCA) have not been evaluated. To evaluate the expression of cAK isoforms in HCA and examine the role of cAK in the cyclic adenosine monophosphate (cAMP)- and cyclic guanosine monophosphate (cGMP)-mediated control of penile vascular smooth muscle. The expression and distribution of phosphodiesterase type 4 (PDE4) and cAK isoforms in sections of HCA were investigated by means of immunohistochemistry and Western blot analysis. The effects of the cAK inhibitor Rp-8-CPT-cAMPS on the relaxation of isolated preparations of HCA (diameter > 100 µm) induced by rolipram, sildenafil, tadalafil, and vardenafil were studied using the organ bath technique. Investigate the expression of cAK in relation to α-actin and PDE4 in HCA and evaluate the effects of an inhibition of cAK on the relaxation induced by inhibitors of PDE4 and PDE5 of isolated penile arteries. Immunosignals specific for cAKIα, IIα, and IIβ were observed within the wall of HCA. Double stainings revealed colocalization of cAK with α-actin and PDE4. The expression of cAK isoforms was confirmed by Western blot analysis. The reversion of tension induced by inhibitors of PDE4 and PDE5 of isolated penile vascular tissue were attenuated significantly by Rp-8-CPT-cAMPS. Our results demonstrate the expression of cAK isoforms in the smooth musculature of HCA and its colocalization with PDE4. A significant role for cAK in the regulation mediated by cAMP and cGMP of vascular smooth muscle tone in HCA can also be assumed.

Treatment of carotid artery pseudoaneurysm associated with a CCF with covered stent, a case report and literature review

Objective We present one case of cavernous carotid artery aneurysm associated with a CCF which was successfully treated with covered stent Method A 18 - year - old man presented with a 2 weeks of progressive right - sided ptosis, ophthalmoplegia and proptosis, chetnosis after severe head trauma. A cerebral angiogram demonstrated a right ruptured cavernous carotid artery aneurysm associated CCF. The patient was treated with covered stent. Results A balloon expanded Jostent stent graft was placed across the aneurismal neck and expanded. Immediate angiogram demonstrated an endoleak around the stent. After repositioned the balloon and re - expended, the complete obliteration of aneurysm and shunt was achieved. The postoperative course was uneventful. Conclusions Although the current - generation Jostent stent graft remained some problems in the treatment of cerebral vascular diseases, covered stent provided a valuable approach for the treatment of cavernous carotid artery aneurysm and CCF. Key words: Carotid-cavernous sinus fistula; Intracranial aneurysm; Stents

Increased Levels of Osteocalcin-Positive Endothelial Progenitor Cells in Patients Affected by Erectile Dysfunction and Cavernous Atherosclerosis

Erectile dysfunction (ED) was shown to be the expression of a systemic vascular disease that can precede coronary artery disease of some years. Endothelial progenitor cells (EPCs) are a population of circulating cells with endothelial-regenerative potential that may be reduced in ED and coronary patients. Recently, increased levels of osteocalcin (OCN)-positive EPC have been reported in coronary patients. Investigate the correlation between OCN-positive EPC and cavernous atherosclerotic lesion in ED patients. A total of 35 subjects (20 ED patients and 15 controls) were evaluated in our andrological center and enrolled in the study. All subjects underwent routine clinical examination. Patients were also evaluated with high resolution echo color doppler of penile districts (intima media thickness [IMT] before and after intracavernous alprostadil injection) and circulating levels of progenitor cells (PC), EPC, and OCN-positive fraction of EPC. A progressive reduction of circulating EPC with the severity of cavernous artery atherosclerosis was found. Conversely circulating OCN-positive EPC levels undergo to a significant increase with cavernous atherogenesis progression. OCN-positive EPC levels in association with penile-color Doppler ultrasound evaluation of cavernous IMT could be predictive markers of subsequent coronary artery disease in ED patients.

Penile involvement in Systemic Sclerosis: New Diagnostic and Therapeutic Aspects

Systemic Sclerosis (SSc) is a connective tissue disorder featuring vascular alterations and an immunological activation leading to a progressive and widespread fibrosis of several organs such as the skin, lung, gastrointestinal tract, heart, and kidney. Men with SSc are at increased risk of developing erectile dysfunction (ED) because of the evolution of early microvascular tissutal damage into corporeal fibrosis. The entity of penile vascular damage in SSc patients has been demonstrated by using Duplex ultrasonography and functional infra-red imaging and it is now clear that this is a true clinical entity invariably occurring irrespective of age and disease duration and constituting the ‘‘sclerodermic penis”. Once-daily phosphodiesterase type-5 (PDE5) inhibitors improve both sexual function and vascular measures of cavernous arteries by improving surrogate markers of endothelial dysfunction, that is, plasma endothelin-1 and adrenomedullin levels, which may play a potential role in preventing progression of penile fibrosis and ED. Also, the beneficial effect of long-term PDE5i add-on therapy to SSc therapy in the treatment of Raynaud's phenomenon is described.

To investigate Leo Stent assisted coil embolizatinn of complex intracranial aneurysms

Objective Endovascular treatment of complex and broad-necked aneurysms remains a challenge for the neurovascular physician despite accelerated progress in technology and experience. The Leo stent is a new retractable self-expandable stent. The purpose of this study was to evaluate the feasibility and flexibility of the stent. Method Forty-five complex and broad-necked intracranial aneurysms in 41 patients were treated electively. They were located at the cavernous carotid artery (3),internal carotid artery ophthalmic artery segment(5), internal carotid artery posterior communicating artery segment (23), internal carotid artery bifurcation(1), vertebral artery(8), basilar artery(5). Mean aneurysm size was 7.1 mm. Mean neck size of aneurysms was 4.8 mm. Results There were 31 (69%) aneurysm occlusions, 8 (18%) residual aneurysms, and 6 (13%) neck remnants. Stent deployment was successful in all lesions. Clinical follow up was available in 41 patients. Angiographic follow up was available in 29 patients with 31 aneurysms. There were one thromboembolic events related to the deployment of the Leo stent, two asymptomatic parent artery occlusion, one symptomatic parent artery occlusion, and one intracerebral hematoma. Conclusions Primary treatment of complex and broad-necked intracranial aneurysms using the Leo stent is feasible and effective. Although results at follow-up are encouraging, further studies are needed to evaluate the long-term stability of aneurysmal occlusion and tolerance to the stent. Key words: Endovascular therapy; Intracranial aneurysm; Stent

Risperidone-Induced Priapism

Risperidone-Induced Priapism