C. Riquelme

Application of Combined Stenting and Coiling for Endovascular Treatment of Intracranial Aneurysms: Preliminary Experience in Five Cases

1163 patient developed a limited subarachnoid haemorrhage (Fisher II, Hunt-Hess I) and partially regressive monocular blindness after embolisation. Although EVT was sucessfully achieved, one female died during immediate post-embolization period due to neurological complications related to the haemorrhage (case 2). After release, one stent slid proximally but coil placement helped to position it (case 4). In other case, coiling was not feasible after stent placement due to reduced volume of dysplasic pouches (case 5). In all cases, immediate angiograms demonstrated exclusion of all aneurysms with good distal blood flow and permeability of all collateral branches. Long-term angiographic controls (mean time 16.3 months) showed persistent occlusion of all aneurysms. All patients experienced a significant improvement of their clinical status during follow-up.

Large and Giant Aneurysms: Outcome of Endovascular Treatment

After a multidisciplinary discussion, we proposed endovascular approach in 13 cases. One patient with a giant, serpentine, right ICA aneurysm and important mass effect (reduction of visual acuity and right ocular palsy) was not treated because of an anomalous configuration of cererbral vascular anatomy (non functional circle of Willis with congenital anomaly of right cerebral circulation). Eight of our patients were treated in emergency conditions because of acute subarachnoid haemorrhage. Three of them (37,5% of ASH) belonged to the high grade group (IV-V) according to the Hunt and Hess clinical status scale. Average embolization time (from placement of microcatheter in aneurysmal pouch to last coil detachment) was 55,8 min/aneurysm. We used a total of 218 coils (16,8 coils/aneurysm). One patient having a partially-calcified, thrombosed, giant aneurysm of Purpose

Endovascular Treatment of Skull Base Dural Fistulae by Venous Retrograde Approach Using Mechanical Detachable Coils: Preliminary Study of Three Cases

Two male aged of 54 and 55 years and 1 female aged of 39 years with complex dural DAVF situated in skull base.Two of them were symptomatic. Multiple arterial feeders arising from external and internal carotid arteries were detected and complex venous drainage to the basal vein of Rosenthal into the vein of Galen and straight sinus were evidenced by angiographic examination. All patients initially supported multiple seances of endovascular embolization with polyvinyl-alcohol particles, and in one case complementary mechanically detachable coil occlusion of the meningeal feeders. These interventions demonstrated to be insufficient. All three patients finally underwent one seance of EVT by retrograde venous route using a meEndovascular Treatment of Skull Base Dural Fistulae by Venous Retrograde Approach Using Mechanical Detachable Coils Preliminary Study of Three Cases.

Utility of Three-Dimensional Digital Subtraction Angiography for Preinterventional and Presurgical Analysis of Angioarchitecture of Intracranial Aneurysms

In all cases, neck situation was well depicted by 3D-DSA. SDSA and 3D-DSA proved to be equally accurate in measuring aneurysm dimensions. 3D-DSA showed extension of the neck to proximal branches in 9 cases, and normal vessels arising from the pouch in 6. In 6 aneurysms, critical dysplasic areas not well identified by SDSA, were well defined by 3D-DSA. Morphology of all complex aneurysms were better depicted by 3D-SDA.Twenty-seven aneurysms were treated by endovascular embolization. Utility of Three-Dimensional Digital Subtraction Angiography for Preinterventional and Presurgical Analysis of Angioarchitecture of Intracranial Aneurysms

Three-Dimensional Digital Subtraction Angiography: Interest in Pretherapeutic Analysis of Anterior Communicating Artery Complex Aneurysms

From November 2001 to May 2002, 45 patients were referred to our Department with clinical suspicion of cerebral aneurysm. All patients underwent a standard digital subtraction angiography (SDSA) and a 3D-DSA. Fourteen patients showed one aneurysm of the anterior communicating artery (ACoA) complex.Two patients presented multiple aneurysms, which one was situated at the ACoA complex. One patient had mirror kissing A1-A2 junction aneurysms. From this group, 16 patients presented subarachnoid haemorrhage (SAH), and in one case diagnostic was made after an incidental finding during radiologic evaluation for chronic headaches.

Interest in Guide Dependant Micro-Catheterization of Small Arteriovenous Malformations and Dural Arteriovenous Fistulae

From August 1995 to March 2002, of 21 AVMs and 17 AVF, 19 patients, aged 17 to 69 years, 13 men and six women presenting nine small size AVMs (less than 1 cm nidus, low flux) and 10 AVFs underwent a guide dependent microcatheterism. The symptomatology was haematomas in 11 cases, intraventricular haemorrhage 1 case, temporal epilepsy one case, headaches and 2 cases, dyphagia troubles and tetraparesia one case, chronic headaches three cases. All cases were made with general anaesthesia, hypotension pressure induce by the anaesthesia and under heparin. The microcatheter used were Magic 1.8-1.2, Mag 3-2, Marco 18 from Balt, Starfast 18 from Nycomed, Prowler 10 from Cordis, and the microguide were Sorcerer 0.07-0.012 from Balt, Terumo 0.012 from Radio Focus. Navigation time was about 10 minutes for the AVMs and 20 minutes for the AVFs. We did not have any complications related with the navigation itself, like thrombosis or arterial perforation.

Multiple Intracranial Aneurysms: Angiographic Study and Endovascular Treatment

From 1994 to 2001, 24 patients underwent EVT for 59 MA. Patients were followed-up clinically and angiographically in a period ranging from six to 93 months (mean time of 22,2) and from four to 69 months (mean time of 19,3), respectively. In the majority of the cases, diagnosis was made after haemorrhage, disclosing multiple aneurysms, usually associated in double. As most of them were inall aneurysms. And when? As a rule we aimed the treatment for all, nevertheless it was not always possible. In this case problem to the feasibility of endovascular treatment were faced in almost Multiple Intracranial Aneurysms Angiographic Study and Endovascular Treatment

Spontaneous Occlusion of a Foramen Magnum Dural Arteriovenous Fistula with Spinal Venous Drainage

A sixty-three-year-old man with a history of arterial hypertension and hyperthyroidism presented a rapidly progressive myelopathy, characterized by paresthesia of both feet, gait disturbance, weakness and fatigability of lower extremities, bladder sphincter troubles, and constipation. Magnetic resonance (MR) imaging showed some small, round-shaped areas of hyperintensity in lobar white matter and abnormal high signal intensity in rhombencephalic area. An rounded structure with “flow void” signal compressed the anterior aspect of an hyperintense medulla oblongata (figure 1). An enlarged cervical spinal cord, with central hyperintense signal associated to cervical stenosis and perimedullary flow voids in T2-weighted sequences was also evidenced (figure 2). MR scans of dorsolumbar spine disclosed abnormal hyperintensity of high dorsal spinal cord with multiple tortuous, dilated vascular structures with “flow void” signal running towards the conus medullaris (figure 3). Spinal angiography was normal but cerebral angiography disclosed a foramen magnum DAVF with perimedullary venous drainage. Main arterial feeders were the posterior meningeal branch of V4 segment of the left vertebral artery (figure 4) and the neuromeningeal branch of the left ascending pharyngeal artery (figure 5).

Endovascular Treatment by Mechanically Detachable Coils: A Safe Way to deal with Spinal Cord Arteriovenous Fistula

1302 An eighteen-year-old boy with disease presented a progressive myelopathy, characterized by diminution of muscular strength at the right superior member, associated with spastic paraparesia and sfincterian trouble. Magnetic resonance imaging (MRI, figure 1) and spinal arteriography disclosed a spinal cord perimedullary fistula, whose feeders were the following radiculo-medullary arteries: right eighth thoracic, right third lumbar (figure 2), left seventh (Adamkiewicz) and left ninth thoracic, left first (figure 3) and second lumbar (figure 4). The outflow was ensured by a dilated venous system rising up to the posterior skull base via both lateral sinuses (figure 2). Endovascular treatment was performed in two sessions by mechanically detachable coils (DCS/ MDS). At the first session, a Prowler 10 microcatheter (Cordis Endovascular System, USA) was advanced over a Terumo microguidewire 0.012 with 45° tip angulation (Terumo, Belgium), followed by detachment of DCS coils. We could then exclude the first, second (figure 5) and fourth lumbar posterior radiculo-medullary arteries at the left side and the following feeders persisted: eighth Endovascular Treatment by Mechanically Detachable Coils A Safe Way to deal with Spinal Cord Arteriovenous Fistula