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Central vein disease (CVD) is a well-known complication of central venous cannulations, indwelling dialysis catheters, and arteriovenous grafts. Brachiocephalic vein (BCV) stenosis or thrombotic occlusion can occur in dialysis patients, and the presence of an ipsilateral arteriovenous fistula can cause cerebral venous hypertension due to retrograde flow in the ipsilateral jugular vein. A 53-year-old man receiving hemodialysis (left brachiocephalic hemodialysis fistula) presented with impaired consciousness and seizures related to status epilepticus due to left temporal multifocal hemorrhages. Brain computed tomography and angiogram showed left cortical vein congestion without intracranial arteriovenous shunt. Complementary left brachial angiogram showed a left BCV stenosis and jugular and cerebral high-flow venous reflux with cortical venous reflux from the hemodialysis fistula. The left arm shunt resulted in severe cerebral venous hypertension due to ipsilateral stenosis of the BCV. BCV angioplasty immediately resolved the cerebral reflux. Patients with hemodialysis fistulas are at a higher risk of developing these intracerebral hemorrhage complications.

Introduction: This study aimed to evaluate the visibility of stents using high-resolution computed tomography (CT) acquisitions acquired with flat panel detector (XperCT, Allura series, Philips Healthcare, The Netherlands) for endovascular treatment of intracranial aneurysms., Methods: On a 24-month period, 48 patients endovascularly treated by coiling and stenting (59 stents) for intracranial aneurysms were explored by flat panel detector CT technique. A sequence of 620 2D images was acquired over an angle of 240° using a 1,024 × 1,024 pixel matrix detector within a 48-cm field of view. The images were retrospectively analyzed independently by two neuroradiologists. Evaluation criteria were percentage of visualization of the stents and stent deployment (kinking or unsatisfactory deployment of the stent)., Results: Evaluation of the stent was feasible for all the patients. Stent visibility by XperCT was overall estimated at 76% of the stent length. Difficulties to analyze the stents were related to coil artifacts but not to packing density or aneurysm location. Stent length visualization was higher when the acquisition was performed before additional coiling (P < 0.0001). Mild kinking/misdeployment was noticed in 22% of the cases., Conclusion: XperCT technique provides multiplanar and 3D reconstructions that allows for a satisfying visualization of intracranial stents. This CT-like acquisition should be performed after the stent deployment and before coiling, in order to obtain better stent visualization.

Intra-arterial infusion of chemotherapy into the ophthalmic artery for treatment of retinoblastoma has been realized after catheterization of the internal carotid and temporary balloon occlusion beyond the orifice of the ophthalmic artery, or more recently after superselective canulation of the ophthalmic artery by a microcatheter. The superselective catheterization of the ophthalmic artery could be cumbersome because of the implantation of the ostium on the carotid siphon or because of the tortuosity of the carotid siphon. We report our experience of using a retrograde approach through the posterior communicating artery that allows a more direct angle of access to the origin of the ophthalmic artery.

Introduction: The purpose of this study is to compare the long-term (≥12 months) angiographic follow-up of aneurysms treated with polymer polyglycolic-lactic acid (PGLA)-coated coils versus bare platinum coils., Methods: Long-term angiographic follow-up results of 90 aneurysms treated exclusively with PGLA-coated coils were retrospectively analyzed and compared to those of 158 aneurysms treated exclusively with bare platinum coils., Results: There were 32 ruptured aneurysms (35.5%) in the PGLA-coated coil group and 62 (39.2%) in the bare platinum coil group. The mean angiographic follow-up was 29 months in the PGLA-coated coil group versus 27 months in the bare platinum coil group (P = 0.2297). The mean time to angiographic recurrence was 14 months in the PGLA-coated coil group versus 18 months in the bare platinum coil group (P = 0.1088). Recurrence rates were 35.6% (32/90) and 31.0% (49/158) in the PGLA-coated coil and bare platinum coil groups, respectively (P = 0.4837). The major recurrence justifying retreatment was 5.6% (5/90) in the PGLA-coated coil group versus 6.7% (10/158) in the bare platinum coil group (P = 1.000)., Conclusion: PGLA-coated coils provided no better long-term recanalization rates than bare platinum coils.

Introduction: In the settings of stroke, a non-invasive high-resolution imaging modality to visualize the arterial intracranial circulation in the interventional lab is a helpful mean to plan the endovascular recanalization procedure. We report our initial experience with intravenously enhanced flat-detector CT (IV FDCT) technology in the detection of obstructed intracranial arteries., Methods: Fourteen consecutive patients elected for endovascular stroke therapy underwent IV FDCT. The scans were intravenously enhanced and acquired in accordance with the previously calculated bolus arrival time. Images were processed on a commercially available workstation for reconstructions and 3D manipulation. Occlusion level and clot length, the quality of collateral vessels, and the patency of anterior and posterior communicating arteries were assessed., Results: IV FDCT was performed successfully in all the cases and allowed for clot location and length visualization, assessment of communicating arteries patency, and evaluation of vessel collateral grade. Information obtained from this technique was considered useful for patients treated by endovascular approach. Retrospective review of the images by two independent readers was considered accurate and reproducible., Conclusions: IV FDCT technology provided accurate delineation of obstructed vessel segments in acute ischemic stroke disease. It gave a significant help in the interventional strategy. This new technology available in the operating room might provide a valuable tool in emerging endovascular stroke therapy.

Introduction: Morphology of the Silk stent (Balt, Montmorency, France) after deployment is not fully understood, especially in tortuous vessels. An in vitro study was conducted to study morphology and flow-diverting parameters of this stent., Methods: Two sets of different-sized and curved polytetrafluoroethylene tubes were studied. To simulate the aneurysm neck, a small hole was created in a tube. A stent was placed in each of the different tubes. Angiographic computerized tomography and macroscopic photography were then obtained. The images were analyzed to calculate a Percentage of Area Coverage (PAC)., Results: Good stent conformability was observed. The PAC was 21% in the straight model with matched stent and vessel diameter. In the straight model with an oversized stent, the PAC was increased. In the curved models, dynamic wire repositioning occurred. The repositioning was affected by the size of the stent and the angle of the vessel curve. Compared to the straight model, this increased the PAC in two instances: on the convexity (oversized stent), and on the concavity (matched stent and vessel diameter). The PAC did not significantly change at the sides of the curve., Conclusions: By design, the wires of the silk stent move relative to each other. In a curved model, the PAC is different at the convexity, concavity, and lateral walls. The stent diameter affects the PAC. These results are clinically relevant because it is desirable to maximize and minimize the PAC across the aneurysm neck and branch vessel orifice, respectively.

Introduction: The pipeline embolization device (PED, Chestnut Medical, Menlo Park, CA, USA) has been used in our department since September 2008. The first-generation PED had limited radio-opacity. Before September 2008, we began obtaining an angiographic computed tomography (ACT) before and after each procedure to detect intracranial complications. We retrospectively examined the ACT of our patient's with the PED to evaluate the in vivo stent morphology., Methods: Twelve patients had a PED placed in our department from September 2008 to January 2009. The stent morphology (stent profile and wall apposition) of three segments of each stent was evaluated., Results: Metal coils adjacent to the stent created too much artifact to evaluate the stent morphology in 4 of 12 patients. Two of the 12 patients were excluded for other reasons. Post-processing of the ACT images was necessary to optimize the evaluation of the stent morphology. Six intracranial PEDs could be adequately evaluated by the ACT, and for these particular cases, 18 of 18 stent segments showed an optimal stent profile and 14 of 18 stent segments showed optimal arterial wall apposition., Conclusion: ACT provided detailed images of the morphology of the PED in six patients. ACT helped detect two stent segments that required balloon dilation to improve the stent-arterial wall apposition; and during the retrospective analysis (after refining post-processing techniques), we identified one additional stent with suboptimal arterial wall apposition. The main limitation of the ACT was the additional radiation dose to the patient.

A 4-year-old girl suffered intraventricular and subarachnoid hemorrhage during endoscopic third ventriculostomy. Cerebral angiography revealed a traumatic basilar aneurysm secondary to basilar artery injury. The aneurysm was treated with selective endovascular embolization using Guglielmi detachable coils. We review some therapeutic features of traumatic basilar aneurysms after endoscopic third ventriculostomy and describe the feasibility of endovascular selective therapy to manage these lesions successfully.

A 45-year-old man presented with acute right orbital pain and right-sided headache. Magnetic resonance imaging (MRI) and cerebral angiography revealed a dural arteriovenous fistula (DAVF) of the lesser sphenoid wing region. The lesion was endovascularly treated by transarterial embolization with Onyx (ethyl vinyl alcohol; Micro Therapeutics, Irvine, Calif.). We review some anatomical and therapeutic features involving DAVFs of this region and describe the feasibility of the use of Onyx in the treatment of these lesions.

We report the case of a 58-year-old man with a giant partially thrombosed anterior communicating artery aneurysm, which presented with mass effect. Our treatment strategy consisted of endovascular aneurysm circulatory exclusion prior to surgical resection. To do so, we first occluded both the two A1 segments and the aneurysm neck with a neck-bridge device to prevent further coil migration within the aneurysm sac. Five days later, the aneurysm was surgically removed.