Bioactive refinement for endosaccular treatment of intracranial aneurysms

Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and material science have led to a novel generation of coil technologies for aneurysm embolisation that address clinical challenges of aneurysm recurrence. This review presents an overview of modified surface coil technologies and summarises the state of the art regarding their efficacy and limitations based on experimental and clinical results. We also present potential perspectives to develop biologically optimised devices.

Reversible cerebral vasoconstriction syndrome in the context of recent cerebral venous thrombosis: Report of a case

INTRODUCTION

Reversible cerebral constriction syndrome and cerebral venous thrombosis are two rare conditions. Reversible cerebral constriction syndrome affects the cerebral arteries and the pathology is still largely unknown. To date, no physiological link with cerebral venous thrombosis has been reported.

CASE RESULTS

We report here the case of a 24-year-old woman who presented a reversible cerebral constriction syndrome in the setting of a cerebral venous thrombosis. Cerebral venous thrombosis had developed in her left lateral venous sinus, within the stent placed one year before, in order to treat an idiopathic intracranial hypertension.

DISCUSSION

The co-occurrence of cerebral venous thrombosis and reversible cerebral constriction syndrome in the same patient raises the issue of a potential link between them. We discuss the potential common trigger factors in this case: recent hormonal therapy; intracranial hypotension iatrogenically induced by lumbar puncture.

Molecular biology of toll-like receptors

Toll-like receptors (TLRs) play important roles in host resistance to infections, but also act as mediators of pathologies in autoimmunity, septic shock, metabolic disease and cancer. TLRs are expressed in sentinel cells of the immune system (most notably dendritic cells and macrophages) and are key sensors of bacteria, viruses, fungi and protozoa (O'Neill 2006). TLRs also recognize endogenous ligands present in tissues and cells in the absence of infection (Kawai and Akira 2005; Nizet 2006; Kim et al. 2009). In this review, the TLRs are characterized at the cellular level with emphasis on TLR-mediated signaling pathways along with their negative regulation, including specificity of the response(s) at the promoter level.

Promoter-context as a determinant of glucocorticoid receptor-responsiveness to activation of p38 and JNK mitogen-activated protein (MAP) kinases

MAP kinases JNK and p38 play an important role in many immune and inflammatory processes, whereas glucocorticoids exert immunosuppressive and anti-inflammatory activities. We found previously that activation of p38 or JNK inhibits glucocorticoid receptor (GR)-mediated transcriptional activation of a mouse mammary tumor virus (MMTV) promoter-driven luciferase construct in HeLa cells. It appears that this effect is DNA regulatory element-specific, since p38 or JNK activation stimulates GR-dependent transcription from TAT3-ADH promoter-luciferase construct in the same cells. The apparent promoter-specificity of this action suggests that not all glucocorticoid-activated genes are negatively regulated by p38 or JNK. Using different MMTV/TAT3 chimeric reporters we demonstrate that the presence of other accessory binding sites of the MMTV construct contributes to the inhibitory effect of activated p38 or JNK on the MMTV-driven transcriptional activity; and diminishes, but does not reverse the stimulation observed using the TAT GREs from the TAT3-ADH promoter-luciferase construct. On the other hand, comparison of the effects of GRE sequences, either in isolation or in the context of the MMTV LTR accessory binding sites, demonstrates that the responsiveness of the GR depends on the GRE sequence; indicating that in addition to transcription factors bound nearby, interaction with the DNA itself modulates GR activity.

Use of the Ascent balloon for a 2-in-1 remodeling technique: feasibility and initial experience: case report

BACKGROUND AND IMPORTANCE

To present the feasibility of using the Ascent balloon, a new double-lumen remodeling balloon, for a new 2-in-1 technique allowing coiling through the lumen of the balloon without the use of an additional coiling microcatheter. Remodeling technique had enlarged the indications for endovascular treatment of intracranial aneurysm. Nevertheless, one of the limitations of this technique is that it requires using 2 devices in the same parent artery.

CLINICAL PRESENTATION

A 55-year-old woman presented with a 7.7 × 4.5-mm incidental anterior communicating artery aneurysm. Only 1 A1 segment (left side) was patent on the cerebral angiogram. A 6F Fargo Max guiding catheter was positioned in the left petrous internal carotid artery. The Ascent balloon was placed in front of the neck of the aneurysm after navigation on a Traxcess 0.014-in guidewire. Coiling of the aneurysm sac was performed via 1 lumen of the device under iterative inflations of the balloon through the second lumen.

CONCLUSION

This new 2-in-1 technique using a sole remodeling balloon without an additional coiling microcatheter is very promising, especially in cases of a small-caliber parent artery.

[Chemoembolization of symptomatic bone metastases: technical considerations and therapeutic effectiveness]

Chemoembolization of bone metastases is defined by the intraarterial perfusion of a chemotherapy agent followed by microparticles embolization to improve tissue impregnation. This technique increases the local concentration of the chemotherapy agent. Tumor response (stable or reduced tumor size) is achieved in 30-80% of cases with symptomatic relief in over 80% of cases. The indications, technical considerations, and effectiveness of this procedure will be reviewed.

Platelet aggregation in intracranial stents may mimic in-stent restenosis

We report the case of an early ISR that was due to platelet aggregation despite correct observance of a standard antiplatelet regimen. Biologic testing showed clopidogrel inefficiency, and ISR disappeared on angiography after a loading dose of clopidogrel. This result suggested that the arterial lumen reduction was due to platelet aggregation rather than in-stent myointimal hyperplasia. This observation emphasizes the importance of verifying the efficacy of clopidogrel before placing a stent.

Facial vein catheterization for transvenous embolization of the cavernous sinus. Technique and advantages of the direct jugular vein approach - report of three cases

SUMMARY

We describe three cases of transvenous embolization of arteriovenous fistulas of the cavernous sinus, achieved through the facial vein approach. The facial vein was catheterized from a jugular vein access. This cervical approach offered good stability to the guiding catheter that permitted us to negotiate difficult curves of the facial vein and to recanalize venous thrombosis in one case.

Orgasmic headache and middle cerebral artery dissection

A patient with a 20 year history of primary orgasmic headache is described who, after suffering an unusually severe episode of orgasmic headache was found to have a middle cerebral artery dissection. This unusual association of primary and secondary orgasmic headache emphasises the need for a thorough diagnostic examination when the orgasmic headache differs from that of previous episodes or is associated with neurological symptoms.