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Grüter BE, Wanderer S, Andereggen L, Tortora A, Gruber P, Anon J, Diepers M, Schubert G, Remonda L, Marbacher S. Incidence and Outcome of Peri-interventional Vasospasm During Endovascular or Microsurgical Treatment of Unruptured Intracranial Aneurysms. Neurosurgery 2023; 92:599-606. [PMID: 36512826 DOI: 10.1227/neu.0000000000002253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Peri-interventional vasospasm (PIVS) is associated with high risk of delayed cerebral vasospasm (DCVS), delayed cerebral ischemia, and poor outcome after aneurysmal subarachnoid hemorrhage. However, the incidence rate associated with treatment of unruptured intracranial aneurysm (UIA) remains unclear. OBJECTIVE To define the incidence and clinical significance of PIVS in UIA repair based on intraoperative/peri-interventional digital subtraction angiography. METHODS A consecutive series of 205 patients who underwent UIA treatment by means of microsurgical clipping (n = 109) or endovascular coil embolization (n = 96) was assessed for the occurrence of PIVS. In all cases, PIVS was detected, measured, and classified using intraoperative/peri-interventional digital subtraction angiography. Severity of PIVS, association of PIVS with the development of DCVS, and neurological outcome were analyzed. RESULTS Intraoperative PIVS was present in n = 14/109 (13%) patients with microsurgical clipping. Of these, caliber irregularities were mild (n = 10), moderate (n = 3), and severe (n = 1). In endovascularly treated patients, 6/96 (6%) developed PIVS, which were either mild (n = 3) or moderate (n = 3). Management in all cases included immediate intensive blood pressure management and application of topical papaverine or intra-arterial nimodipine immediately on detection of PIVS. No patient developed DCVS or lasting neurological deficits attributable to PIVS. CONCLUSION This series revealed a relatively high overall incidence of PIVS (10%). However, no association of PIVS with the development of DCVS or poor outcome was found. In contrast to ruptured intracranial aneurysms, PIVS in unruptured intracranial aneurysms-if immediately and adequately addressed-seems to be benign and without sequelae for patient's functional outcome.
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Affiliation(s)
- Basil E Grüter
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, University of Bern, Aarau, Switzerland
| | - Angelo Tortora
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Gruber
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Anon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Gerrit Schubert
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, University of Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, University of Bern, Aarau, Switzerland
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Russell S, Chamberlin JH, Burt JR, Kabakus IM. A Case Report of Brachiocephalic Vein Spasm Secondary to Peripherally Inserted Central Catheter. Cureus 2022; 14:e27037. [PMID: 35989840 PMCID: PMC9388257 DOI: 10.7759/cureus.27037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Vascular spasm is well known and studied in the arterial system. There are only a few cases reported related to central venous spasms. We present the case of a 63-year-old male with an extensive medical history, including deep vein thrombosis (DVT), who underwent peripheral insertion of a central catheter in his left upper extremity with subsequent development of left upper extremity edema. The central catheter was removed before the patient underwent a contrast-enhanced computed tomography of the chest which revealed severe narrowing of the left brachiocephalic vein, consistent with venospasm in the clinical setting. Nitroglycerin might be useful to prevent vasospasm, or it might also be used for treatment. In our case, the catheter was removed, and no subsequent treatment was necessary.
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Advanced vasospasm in carotid stenting using the distal filter-type embolic protection device: A case report. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.1000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Marbacher S, Bircher B, Vogt DR, Diepers M, Remonda L, Fandino J. Periinterventional Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage Predicts an Unfavorable Clinical Course. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okaa021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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5
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Voss S, Ernst A, Erlebach M, Ruge H, Sideris K, Bleiziffer S, Voss B, Tassani-Prell P, Mayr NP. Effects of a dual-filter-based cerebral embolic protection device in transcatheter aortic valve replacement on cerebral oxygen saturation: A prospective pilot study. J Card Surg 2021; 36:1241-1248. [PMID: 33484180 DOI: 10.1111/jocs.15355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The Sentinel Cerebral Protection System (Sentinel-CPS) is increasingly used in transcatheter aortic valve replacement (TAVR). However, the impact of inserting the Sentinel-CPS inside the brain-supplying arteries on cerebral perfusion and oxygenation is unknown. METHODS Twenty patients undergoing transfemoral TAVR with (n = 10) and without (n = 10) cerebral embolic protection using the Sentinel-CPS were prospectively observed. All patients received conscious sedation and cerebral oxygen saturation (rSO2 ) was continuously measured with near-infrared spectroscopy (NIRS). The cumulative perioperative cerebral desaturation was calculated for each patient by multiplying rSO2 below an individualized desaturation threshold by time. In addition, rSO2 values at the time of Sentinel-CPS insertion, filter positioning, and device retraction were analyzed. RESULTS There was no significant difference in cumulative cerebral desaturation in patients with Sentinel-CPS (median [IQR]) (0 [0/81] s%) and without (median [IQR]) (0 [0/23] s%), p = .762. A total of 6 patients (33.3%) experienced a perioperative decrease in rSO2 below the individualized desaturation threshold (n = 3 with Sentinel-CPS, n = 3 without Sentinel-CPS; p = 1.000). Cerebral desaturation was detected during valve deployment (n = 5) and after postdilatation (n = 1). No desaturation events occurred during Sentinel-CPS insertion, filter positioning, or retraction. CONCLUSION Our pilot study revealed no difference in cumulative perioperative cerebral desaturation between TAVR with and without Sentinel-CPS. Catheter- and filter-based manipulations in the brain-supplying arteries for Sentinel-CPS application were not associated with a decrease of cerebral perfusion and oxygenation.
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Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Annick Ernst
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Tassani-Prell
- Department of Anaesthesiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - N Patrick Mayr
- Department of Anaesthesiology, German Heart Center Munich, Technische Universität München, Munich, Germany
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6
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Shiwani TH, Shiwani H. Intra-arterial anaesthetics for pain control in arterial embolisation procedures: a systematic review and meta-analysis. CVIR Endovasc 2021; 4:6. [PMID: 33399961 PMCID: PMC7785604 DOI: 10.1186/s42155-020-00198-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Purpose A systematic review to determine the effectiveness of intra-arterial anaesthetics on post- operative pain and opioid analgesia requirements in arterial embolisation procedures. Materials and methods A systematic review of the literature was performed (Embase, PubMed, MEDLINE and the Cochrane Library) from inception to 10th August 2020. Randomised controlled trials (RCTs) and cohort studies that utilised intra-arterial anaesthesia during an embolisation procedure for the purposes of pain control were included. Eligibility was assessed by two investigators independently. Results Eight hundred fifty-nine candidate articles were identified, and 9 studies met the inclusion criteria (6 RCTs and 3 retrospective cohort studies). Four studies were of hepatic chemoembolisation and 5 were of uterine artery embolisation. Five hundred twenty-nine patients were treated in total. All studies used lidocaine as the anaesthetic with doses ranging from 20 to 200 mg, and the anaesthetic was delivered varyingly before, during or after embolisation. Pain intensity was converted to a numeric scale from 0 to 10, and opioid doses were converted to milligram morphine equivalent doses. A random-effects meta-analysis model was used to analyse the results of RCTs, and the results of cohort studies were summarised with a narrative synthesis. The meta-analyses suggested that pain scores were reduced by a mean of 1.02 (95% CI − 2.34 to 0.30; p = 0.13) and opioid doses were reduced by a mean of 7.35 mg (95% CI, − 14.77, 0.06; p = 0.05) in the intervention group however neither finding was statistically significant. No serious adverse events were reported. Conclusion Intra-arterial anaesthetic may slightly reduce pain intensity and post-operative opioid consumption following embolisation, however the results are not statistically significant. There is very limited data available on the effect of anaesthetic on length of hospital admission. Whilst no serious adverse events were reported, there are some concerns regarding the effect of lidocaine on the technical success of embolisation procedures that preclude our recommendation for routine use in embolisation procedures. High quality randomised controlled trials are required to elucidate the dose-response effect of lidocaine on opioid consumption and pain following embolisation, particularly in the first few hours post-operatively, as well as effects on duration of hospital stay. Supplementary Information The online version contains supplementary material available at 10.1186/s42155-020-00198-z.
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Affiliation(s)
| | - Hunain Shiwani
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
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7
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Ishigami D, Tsuruta W, Katsumata M, Hosoo H. Mechanically Induced Vasospasm and Postoperative Cerebral Infarction after Coil Embolization of Unruptured Cerebral Aneurysms in Anterior Circulation. Neurol Med Chir (Tokyo) 2020; 60:612-621. [PMID: 33208585 PMCID: PMC7803699 DOI: 10.2176/nmc.oa.2020-0236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We occasionally encounter situations which requires retraction of the guiding system or administration of vasodilatory agents for mechanically induced vasospasm (MVS). However, whether MVS is associated with postoperative cerebral infarction has not been reported.To explore factors associated with MVS and to verify how MVS influences procedure outcomes,we reviewed consecutive cases of unruptured aneurysms in the anterior circulation treated with coil embolization between January 2017 and February 2020. Collected data included patients' clinical characteristics, devices, vessel tortuosity, severity of MVS, diameter of the parent vessel, and procedure duration. Significant MVS was defined as a condition necessitating a pause in the procedure. We also counted postoperative diffusion-weighted imaging (DWI) hyperintense spots (DHS). Parameters associated with MVS and postoperative DHS were investigated by multivariate logistic regression.A total of 103 cases met the eligibility criteria, with significant MVS occurring in 21 cases (20.3%), and postoperative DHS (≥3) confirmed in 30 cases (29.1%). Significant MVS was associated only with larger caliber at the tip of the guiding system compared with the parent vessel (p = 0.001). Postoperative DHS was associated with significant MVS (p = 0.002, OR: 5.313; 95% CI: 1.851-15.254).Significant MVS is a predictor of postoperative cerebral ischemia and occurs in patients with smaller caliber of the parent vessel. In patients with high-risk features for MVS, we should avoid navigating the guiding system forcibly through the narrow parent vessel. In other words, it is crucial to place the large-caliber guiding sheath/catheter proximally and only guide distally the intermediate catheter with better trackability.
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Affiliation(s)
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital
| | | | - Hisayuki Hosoo
- Department of Endovascular Neurosurgery, Toranomon Hospital
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8
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Al-Khafaji AO, Al-Sharshahi ZF, Lee RP, Alsubaihawi ZA, Dolachee AA, Hoz SS. Unilateral absence of the internal carotid artery associated with anterior communicating artery aneurysms: Systematic review and a proposed management algorithm. Surg Neurol Int 2020; 11:221. [PMID: 32874724 PMCID: PMC7451189 DOI: 10.25259/sni_238_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Absence or hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we review the literature on cases with a unilaterally absent ICA associated with Acom aneurysms and provide an illustrative case. Methods: We combined our experience of one case of a unilaterally absent ICA associated with an Acom aneurysm with the 33 existing publications on the same subject in the literature, for a total of 40 cases. We provide a detailed systematic literature review of this association of vascular anomalies, exploring different aspects regarding the collateral pathways and how they impact management strategies and propose a management algorithm to deal with such association. Results: The mean age was 48.2 ± 16.5 years. The aneurysmal rupture was the most common presentation (75%). Agenesis was observed in 70% of patients, followed by hypoplasia (20%) and, finally, aplasia (10%). Lie Type A was the most common pattern of collaterals (50%), with Types B and D being of almost equal proportions. Most aneurysms were located at the A1-Acom junction contralateral to the anomalous side (Fisher’s Exact test; P = 0.03). One case of temporary clipping was reported in the literature. Conclusion: Acom aneurysms in patients with unilateral ICA anomalies, given they are more commonly present contralaterally, could be of acquired etiology, warranting periodic screening in asymptomatic patients. Temporary clipping might be safe in patients with Type D collateral pattern, while those with Types A or B may require intraoperative rupture risk assessment and a tailored management plan to avoid disrupting collateral flow and causing ischemia.
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Affiliation(s)
| | | | - Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Zahraa A Alsubaihawi
- College of Medicine, University of Baghdad, Baghdad, Iraq.,Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | - Ali A Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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9
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Elakkad A, Drocton G, Hui F. Endovascular Stroke Interventions: Procedural Complications and Management. Semin Intervent Radiol 2020; 37:199-200. [PMID: 32419733 PMCID: PMC7224977 DOI: 10.1055/s-0040-1709206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endovascular mechanical thrombectomy has evolved significantly and has become the mainstay and most effective currently available treatment for acute ischemic stroke patients due to large vessel occlusion. Mechanical thrombectomy is presently performed using a stent retriever or stent-like device, an aspiration catheter, or a combination of the two. Much of the literature has focused on the benefits of endovascular mechanical thrombectomy with only limited data about procedural complications and management. Awareness of risk factors and early recognition of these complications can potentially reduce complication rates, improve management, and yield better overall outcomes. In this review, the authors present a description of intraprocedural complications and strategies to prevent and treat these complications.
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Affiliation(s)
- Ahmed Elakkad
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Gerald Drocton
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ferdinand Hui
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
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10
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Verapamil use in interventional neuroradiology: A case series of postoperative pulmonary edema. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Intra-arterial Injection of Lidocaine as a Cell Sensitizer during Irreversible Electroporation. J Vasc Interv Radiol 2020; 31:831-839.e2. [PMID: 32088080 DOI: 10.1016/j.jvir.2019.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/27/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate whether intra-arterial injection of lidocaine enhances irreversible electroporation (IRE) in a liver model. MATERIALS AND METHODS Conventional IRE (C-IRE) and lidocaine-enhanced IRE (L-IRE) were performed in 8 pig livers. Protocol 1 (tip exposure and electrode distance of 2.0 cm each) and protocol 2 (increased tip exposure and electrode distance 2.5 cm each) were used. Animals were sacrificed 3 hours after IRE. Study goals included electrical tissue properties (eg, current, conductivity) during IRE, geometry of IRE zones analyzed using computed tomography and magnetic resonance imaging (eg, volume and sphericity index), degree of acute liver damage, and irreversible cell death analyzed using microscopy (hematoxylin and eosin staining and terminal deoxynucleotidyl transferase deoxyuridine 5-triphosphate nick end labeling). Statistical comparisons were performed using the paired t test and Wilcoxon test. RESULTS All treatments were performed without adverse events. Electrical tissue properties were not significantly different between C-IRE and L-IRE. For protocol 1, the diameter of the largest sphere within the IRE zone was significantly larger for L-IRE than for C-IRE (25.0 ± 4.7 mm vs 18.4 ± 3.1 mm [P = .013]). For protocol 2, the volume of IRE zone was significantly larger for L-IRE compared with C-IRE (46.0 ± 5.4 cm3 vs 22.6 ± 6.4 cm3 [P = .018]), as well as the diameter of the largest sphere within the IRE zone (27.1 ± 2.2 mm vs 19.8 ± 2.3 mm [P = .020]). For protocol 1, a significantly higher degree of irreversible cell death was noted for L-IRE than for C-IRE (1.8 ± 1.0 vs 0.8 ± 1.0 [P = .046]). CONCLUSIONS Intra-arterial injection of lidocaine can enhance IRE in terms of larger IRE zones and an increase of irreversible cell death.
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12
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Padhy SK, Ajayan N, Hrishi AP, Thakkar KD, Sethuraman M. Novel application of near-infrared spectroscopy in detecting iatrogenic vasospasm during interventional neuroradiological procedures. Brain Circ 2019; 5:90-93. [PMID: 31334362 PMCID: PMC6611194 DOI: 10.4103/bc.bc_12_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/03/2019] [Accepted: 06/09/2019] [Indexed: 11/04/2022] Open
Abstract
One of the complications of carotid artery stenting (CAS) is iatrogenic vasospasm caused by mechanical irritation of the blood vessel lumen by a guidewire, catheter, stent retriever, or distal protection devices. Although often self-limiting, the mechanical vasospasm can cause reduction in the cerebral blood flow and result in catastrophic ischemia, especially when undetected and persistent. Real-time cerebral oximetry with near-infrared spectroscopy (NIRS) could detect episodes of cerebral hypoxemia due to vasospasm and facilitate intervention for prevention of hypoxic brain injury during neuro-intervention procedures such as CAS. We present a case scenario where NIRS detected iatrogenic vasospasm even before the conventional tests could identify the event during CAS.
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Affiliation(s)
- Sashmita Kumari Padhy
- Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Neeraja Ajayan
- Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ajay Prasad Hrishi
- Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Keta Deepak Thakkar
- Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Manikandan Sethuraman
- Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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13
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Treatment of refractory headache secondary to intracranial endovascular procedure by transcutaneous electrical nerve stimulation of the occipital nerve. Neurophysiol Clin 2018; 48:309-312. [DOI: 10.1016/j.neucli.2018.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
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14
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Miura I, Kawashima A, Hayashi M, Tanda A, Ishikawa T, Kawamata T. Extracranial internal carotid artery vasospasm during thrombectomy. Neuroradiol J 2017; 31:313-316. [PMID: 28895453 DOI: 10.1177/1971400917731118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The use of a stent retriever increases the risk of intracranial vasospasm. Here, we report the case of a man who developed severe vasospasm in a long segment of the extracranial internal carotid artery after mechanical irritation by a stent retriever inserted for the treatment of acute cerebral ischemia. A 47-year-old right-handed man presented with sudden-onset right-sided weakness and difficulty speaking. The patient's National Institutes of Health Stroke Scale score was 6 and he had an Alberta Stroke Program Early Computed Tomography Score of 9. The patient was started on intravenous alteplase therapy, and an acute thrombectomy was performed. Left internal carotid digital subtraction angiography showed narrowing of the left common and internal carotid arteries and occlusion of the proximal left M1 segment of the middle cerebral artery. A stent retriever was retracted into a guiding catheter placed at the left carotid bulb under continuous suction. Recanalization of the middle cerebral artery was not achieved and there was significant narrowing in a long segment of the extracranial internal carotid artery associated with exacerbation of the patient's aphasia. The cervical vasospasm improved after nicardipine infusion via the catheter. We encountered vasospasm in a long segment of the extracranial internal carotid artery after mechanical irritation by a stent retriever. If a stent retriever is used in a patient with a narrow extracranial internal carotid artery, consideration should be given to using a Penumbra or smaller guiding catheter located in the distal internal carotid artery to prevent irritation to the cervical vessel wall.
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Affiliation(s)
- Isamu Miura
- 1 Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Akitsugu Kawashima
- 2 Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Masataka Hayashi
- 2 Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Akane Tanda
- 2 Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Tomomi Ishikawa
- 2 Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | - Takakazu Kawamata
- 1 Department of Neurosurgery, Tokyo Women's Medical University, Japan
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15
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Alexander MD, Nicholson AD, Darflinger RJ, Settecase F, Cooke DL, Dowd CF, Amans MR, Higashida RT, Hetts SW, Halbach VV. Effects on vessel measurement accuracy and subsequent occlusion after calcium channel blocker infusion during treatment of cerebral aneurysms with the Pipeline embolization device. Interv Neuroradiol 2017; 23:47-51. [DOI: 10.1177/1591019916674916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction/Purpose To achieve aneurysm occlusion, flow diverters (FDs) must be accurately sized to maximize coverage over the neck and induce thrombosis. Catheterization for diagnostic angiography can cause vasospasm that may affect vessel measurements. This study evaluates impacts of intra-arterial infusion of a calcium channel blocker (CCB) on angiographic measurements in patients treated with FDs to determine effects on final diameter of the FD and subsequent occlusion. Materials and methods Pre-treatment measurements were recorded for diameter of the distal and proximal landing zones and maximum and minimum diameters between these segments. Post-treatment measurements of the stent following deployment were recorded at these locations. When CCB was infused, post-infusion pre-treatment measurements were recorded. Rates of occlusion were noted for all patients. T-tests were performed to assess for differences in pre- and post-treatment measurements and rates of occlusion between groups with and without CCB infusion. Results Twenty-eight FDs were deployed to treat 25 aneurysms in 24 patients. CCB infusion was performed prior to deployment of 12 (42.9%) devices. No significant difference was noted between groups for pre- and post-treatment measurement changes. Confirmed aneurysm occlusion was more likely to occur in the CCB infusion group (88.9% vs. 36.4%, p = 0.009). Conclusion Optimization of device sizing is important to increase FD density over the aneurysm neck and promote thrombosis. To improve measurement accuracy, CCB infusion can reduce effects of mild vasospasm. Subsequent aneurysm occlusion was more likely to occur following FD treatment when device size selection was based on measurements performed following CCB infusion.
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Affiliation(s)
- MD Alexander
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - AD Nicholson
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - RJ Darflinger
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - F Settecase
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - DL Cooke
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - CF Dowd
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - MR Amans
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - RT Higashida
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - SW Hetts
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
| | - VV Halbach
- University of California San Francisco, Department of Radiology and Biomedical Imaging, USA
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Lee S, Gong TS, Lee YW, Kim HJ, Kweon CY. The Benefits of Navien™ Intracranial Support Catheter for Endovascular Treatment. J Cerebrovasc Endovasc Neurosurg 2016; 18:234-238. [PMID: 27847767 PMCID: PMC5104848 DOI: 10.7461/jcen.2016.18.3.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Endovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery. The successful treatment of endovascular disease relies on appropriate instruments and the surgeon's skill. Endovascular treatment needs to provide safe and stable access to the catheter cavity. Additionally, it is important to maintain a round shape without changing to an oval shape. The catheter for endovascular treatment has to be flexible and accommodate at least 0.027 inches of inner diameter. The 6-Fr Navien™ Intracranial Support Catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, MA, USA) provides 0.072 inches of inner diameter. Materials and Methods We reviewed 61 cases for 56 cases of endovascular treatment with a Navien catheter. A triaxial system was used for all procedures with femoral arterial access. The Navien catheter was placed in the petrous segment of the internal carotid artery or third segment of the vertebral artery. The patients had various shapes of intracranial arteries, including tortuous vessels. Results The Navien catheter was used for 61 cases of endovascular treatment. We had 59 cases of coil embolization at unruptured and ruptured aneurysms and two cases of stent insertion into the middle cerebral artery. All the cases were successful without any catheter-related complications. Conclusion The Navien catheter is a recently developed catheter that has several strengths compared with previously developed catheters. It provides a more stable environment for endovascular treatment. It provides a cavity sufficient for endovascular treatment devices. Additionally, it is sufficiently flexible to approach tortuous vessels.
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Affiliation(s)
- Siwoo Lee
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Tae-Sik Gong
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Yong-Woo Lee
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Hyo-Joon Kim
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Chang-Young Kweon
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
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